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From the Atlantic Monthly for October, 1862. 



THE SANITARY CONDITION 



O F 



The Army of ihe United States, 



BY EDAYARD JARYIS, M. D., 



OF DORCHESTER, MASS. 




Book J 3 Q 



1862.] 



Sanitary Condition of the Army. 



463 



SANITARY CONDITION OF THE ARMY. 



The power and efficiency of an army 
consist in the amount of the power and 
efficiency of its elements, in the health, 
strength, and energy of its members. No 
army can be strong, however numerous 
its soldiers, if they are weak ; nor is it 
completely strong, unless every member 
is in full vigor. The weakness of any 
part, however small, diminishes, to that 
extent, the force of the whole ; and the 
increase of power in any part adds so 
much to the total strength. 

In order, then, to have a strong and 
effective army, it is necessary not only 
to have a sufficient number of men, but 
that each one of these should have in 
himself the greatest amount of force, the 
fullest health and energy the human body 
can present. 

This is usually regarded in the original 
creation of an army. The soldiers are 
picked men. None but those of perfect 
form, complete in all their organization 
and functions, and free from every defect 
or disease, are intended to be admitted. 
The general community, in civil life, in- 
cludes not only the strong and healthy, 
but also the defective, the weak, and the 
sick, the blind, the halt, the consumptive, 
the rheumatic, the immature in childhood, 
and the exhausted and decrepit in age. 

In the enlistment of recruits, the can- 
didates for the army are rigidly examined, 
and none are admitted except such as 
appear to be mentally and physically 
feound and perfect. Hence, many who of- 
fer their services to the Government are 
rejected, and sometimes the proportion 
accepted is very small. 

In Great Britain and Ireland, during 
the twenty years from 1832 to 1851 
inclusive, 305,897 applied for admission 
into the British army. Of these, 97,457, 
or 32 per cent., were rejected, and only 
208,440, or 68 per cent., were accepted.* 

In France, during thirteen years, 1831 

* Report on the Sanitary Condition of the 
British Army, p. 498. 



to 1843 inclusive, 2,280,540 were offered 
for examination as candidates for the 
army. Of these, 182,664, being too short, 
though perhaps otherwise in possession 
of all the requisites of Ijealth, were not 
examined, leaving 2,097,876, who were 
considered as candidates for examination. 
Of these, 680,560, or 32.5 per cent, were 
rejected on account of physical unfitness, 
and only 1,417,316, or 67.5 per cent., 
were allowed to join the army.* 

The men who ordinarily offer for the 
American army, in time of peace, are 
of still inferior grade, as to health and 
strength. In the year 1852, at the sev- 
eral recruiting-stations, 16,114 presented 
themselves for enlistment, and 10,945, or 
67.9 per cent., were rejected, for reasons 
not connected with health: — 

3,162 too young, 

732 too old, 
1,806 too short, 
657 married, 
2,434 could not speak English, 

32 extremely ignorant, 
1,965 intemperate, 
106 of bad morals, 
51 had been in armies from which 
they had deserted. 



Total, 10,945 

All of these may have been in good 

health. 

Of the remainder, 5,169, who were 
subjects of further inquiry, 2,443 were 
rejected for reasons connected with their 
physical or mental condition : — 

243 mal-formed, 

630 unsound in physical constitution, 

16 unsound in mind, 
114 had diseased eyes, 

55 had diseased ears, 
314 had hernia, 
1,071 had varicose veins, 



Total, 2,443 

Only 2,726 were accepted, being 52.7 
per cent, of those who were examined, 
and less than 1 7 per cent., or about one- 

* Report on the Sanitary Condition of the 
British Army, p. 499. 



464 



Sanitary Condition of the Army. 



[October, 



sixth, of all who offered themselves as 
candidates for the army, in that year.* 

In time of peace, the character of the 
men who desire to become soldiers dif- 
fers with the degree of public prosperity. 
When business is good, most men obtain 
employment in the more desirable and 
profitable avocations of civil life. Then 
a larger proportion of those who are will- 
ing to enter the army are unfitted, by 
their habits or their health, for the occu- 
pations of peace, and go to the rendezvous 
only as a last resort, to obtain their bread. 
But when business falters, a larger and 
a better class are thrown out of work, 
and are glad to enter the service of the 
country by bearing arms. The year 1852 
was one of prosperity, and affords, there- 
fore, no indication of the class and char- 
acter of men who are willing to enlist 
in the average years. The Government 
Reports state that in some other years 
6,383 were accepted and 3,617 rejected 
out of 10,000 that offered to enlist. But 
in time of war, when the country is en- 
dangered, and men have a higher mo- 
tive for entering Its service than mere 
employment and wages, those of a better 
class both as to character and health Hock 
to the army ; and in the present war, the 
army is composed, in great degree, of 
men of the highest personal character 
and social position, who leave the. most 
desirable and lucrative employments to 
serve their country as soldiers. 

As, then, the army excludes, or intends 
to exclude, from its ranks all the defective, 
weak, and sick, it begins with a much 
higher average of health and vigor, a 
greater power of action, of endurance, and 
of resisting the causes of disease, than the 
mass of men of the same ages in civil life. 
It is composed of men in the fulness of 
strength and efficiency. This is the vital 
machinery with which Governments pro- 
pose to do their martial work; and the 
amount of vital force which belongs to 
these living machines, severally and col- 
lectively, Is the capital with which they in- 
tend to accomplish their purposes. Every 

* Medical Statistics of the United States Ar- 
my, 1839-54, p. 625. 



wise Government begins the business of 
war with a good capital of life, a large 
quantity of vital force in Its army. So far 
they do well ; but more is necessary. This 
complete and fitting preparation alone is 
not sufficient to carry on the martial pro- 
cess through weeks and months of labor 
and privation. Not only must the living 
machinery of bone and flesh be well se- 
lected, but its force must be sustained. It 
must be kept in the most effective con- 
dition and In the best and most available 
working order. For this there are two 
established conditions, that admit of no 
variation nor neglect: first, a sufficient 
supply of suitable nutriment, and faithful 
regard to all the laws of health ; and, sec- 
ond, the due appropriation of the vital 
force that Is thus from day to day creat- 
ed. 

A due supply of appropriate food and of 
pure air, sufficient protection and cleans- 
ing of the surface, moderate labor and 
refreshing rest, are the necessary con- 
ditions of health, and cannot be disre- 
garded. In the least degree, without a 
loss of force. The privation of even a 
single meal, or the use of food that is 
hard of digestion or innutritious, and the 
loss of any of the needful sleep, are fol- 
lowed by a corresponding loss of effective 
power, as surely as the slackened fire in 
the furnace is followed by lessened steam 
and power In the engine. 

Whosoever, then, wishes to sustain his 
own forces or those of his laborers with 
the least cost, and use them with the 
greatest effect, must take Nature on her 
own terms. It is vain to try to evade 
or alter her conditions. The Kingdom 
of Heaven is not divided against itself. 
It makes no compromises, not even for 
the necessities of nations. It will not 
consent that any one, even the least, of its 
laws shall be set aside, to advance any 
other, however important. Each single 
law stands by itself, and exacts complete 
obedience to its own requirements : it 
gives Its own rewards and Inflicts its own 
punishments. The stomach will not di- 
gest tough and hard or old salted meats, 
or heavy bread, without demanding and 



1862.] 



Sanitary Condition of the Army. 



465 



receiving a great and perhaps an almost 
exhausting proportion of the nervous en- 
ergies. The nutritive organs will not cre- 
ate vigorous muscles and effective limbs, 
unless the blood is constantly and appro- 
priately recruited. The lungs will not 
decarbonize and purify the blood with 
foul air, that has been breathed over and 
over and lost its oxygen. However noble 
or holy the purpose for which human 
power is to be used, it will not be created, 
except according to the established con- 
ditions. Tlie strength of the warrior in 
battle cannot be sustained, except in the 
appointed way, even though the fate of 
all humanity depend on his exertions. 

Nature keeps an exact account with 
all her children, and gives power in pro- 
portion to their fulfilment of her condi- 
tions. She measures out and sustains 
vital force according to the kind and 
fitness of the raw material provided for 
her. When we deal liberally with her, she 
deals liberally with us. For everything 
we give to her she makes a just return. 
The stomach, the nutrient arteries, the 
lungs, have no love, no patriotism, no 
pity ; but they are perfectly honest. The 
healthy digestive organs will extract and 
pay over to the blood-vessels just so much 
of the nutritive elements as the food we 
eat contains in an extractible form, and 
no more ; and for this purpose they will 
demand and take just so much of the 
nervous energy as may be needed. The 
nutrient arteries will convert into living 
flesh just so much of the nutritive ele- 
ments as the digestive organs give them, 
and no more. The lungs will send out 
from the body as many of the atoms of 
exhausted and dead flesh as the oxygen 
we give them will convert into carbonic 
acid and water, and this is all they can 
do. In these matters, the vital organs 
are as honest and as faithful as the boiler, 
that gives forth steam in the exact ratio of 
the heat which the burning fuel evolves 
and the fitness of the water that is sup- 
plied to It ; and neither can be persuaded 
to do otherwise. The living machine of 
bone and flesh and the dead machine of 
iron prepare their forces according to 

VOL. X. 30 



the means they have, not according to 
the ulterior purpose to which those forces 
are to be applied. They do this alike for 
all. They do it as well for the sinner as 
for the saint, — as well for the traitorous 
Secessionist striving to destroy his country 
as for the patriot endeavoring to sustain it. 

In neither case is it a matter of will, 
but of necessity. The amount of power 
to be generated in both living and dead 
machines Is simply a question of quality 
and quantity of provision for the purpose. 
So much food, air, protection given pi'o- 
duce so much strength. A proposition 
to reduce the amount of either of these 
necessarily involves the proposition to 
reduce the available force. Whoever 
determines to eat or give his men less 
or poorer food, or impure air, practically 
determines to do less work. In all this 
management of the human body, we are 
sure to get what we pay for, and we are 
equally sure not to get what we do not 
pay for. 

All Governments have ti-Ied, and are 
now, in various degrees, trying, the ex- 
periment of privation in their arinies. 
The soldier cannot carry with him the 
usual means and comforts of home. He 
must give these up the moment he enters 
the martial ranks, and reduce his appa- 
ratus of hving to the smallest possible 
quantity. He must generally hmit him- 
self to a portable house, kitchen, cook- 
ing-apparatus, and wardrobe, and to an 
entire privation of furniture, and some- 
times submit to a complete destitution of 
everything except the provision he may 
carry In his haversack and the blanket 
he can carry on his back. When sta- 
tionary, he commonly sleeps In barracks; 
but he spends most of his time in the 
field and sleeps in tents. Occasionally 
he is compelled to sleep in the open air, 
without any covering but his blanket, 
and to cook In an extemporized kitchen, 
which he may make of a few stones piled 
together or of a hole in the earth, with 
only a kettle, that he carries on his back, 
for cooking-apparatus. In all cases and 
conditions, whether in fort or in field, in 
barrack, tent, or open air, he is limited 



466 



Sanitary Condition of the Army. 



[October, 



to the smallest artificial habitation, the 
least amount of furniture and convenien- 
ces, the cheapest and most compact food, 
and the rudest cookery. He is, there- 
fore, never so well protected against the 
elements, nor, when sleeping under cover, 
so well supplied with air for respiration, 
as he is at home. Moreover, when lodg- 
ing abroad, he cannot take his choice of 
places; he is liable, from the necessities 
of war, to encamp in wet and malarious 
spots, and to be exposed to chills and mi- 
asms of unhealthy districts. He is neces- 
sarily exposed to weather of every kind, 
— to cold, to rains, to storms ; and when 
wet, he has not the means of warming 
himself, nor of drying or changing his 
clothing. His life, though under martial 
discipline, is irregular. At times, he has 
to undergo severe and protracted labors, 
forced marches, and the violent and long- 
continued struggles of combat ; at other 
times, he has not exercise sufficient for 
health. His food is irregularly served. 
He is sometimes short of provisions, and 
compelled to pass whole days in absti- 
nence or on short allowance. Occasion- 
ally he cannot obtain even water to drink, 
through hours of thirsty toil. No Govern- 
ment nor managers of war have ever yet 
been able to make exact and unfailing 
provision for the wants and necessities 
of their armies, as men usually do for 
themselves and their families at home. 



SUPPOSED DAXGERS TO THE SOLDIER. 

From the earliest recorded periods of 
the world, men have gone forth to war, 
for the purpose of destroying or overcom- 
ing their enemies, and with the chance 
of being themselves destroyed or over- 
thrown. Public authorities have gen- 
erally taken account of the number of 
their own men who have been wound- 
ed and killed in battle, and of the casu- 
alties in the opposing armies. Gunpow- 
der and steel, and tlie manifold weap- 
ons, instruments, and means of destruc- 
tion in the hands of the enemy are com- 
monly considered as the principal, if not 
the only sources of danger to the soldier, 



and ground of anxiety to his friends ; and 
the nation reckons its losses in war by 
the number of those Avho were wounded 
and killed in battle. But the suflering 
and waste of life, apart from the combat, 
the sickness, the depreciation of vital 
force, the withering of constitutional en- 
ergy, and the mortality in camp and for- 
tress, in barrack, tent, and hospital, have 
not usually been the subjects of such 
careful observation, nor the grounds of 
fear to the soldier and of anxiety to those 
who are interested in his safety. Conse- 
quently, until within the present century, 
comparatively little attention has beeu 
given to the dangers that hang over the 
army out of the battle-field, and but 
little provision has been made, by the 
combatants or their rulers, to obviate or 
relieve them. No Government in former 
times, and few in later years, have taken 
and published complete accounts of the 
diseases of their armies, and of the deaths 
that followed in consequence. Some such 
records have been made and printed, but 
these are mostly fragmentary and par- 
tial, and on the authority of individu- 
als, officers, surgeons, scholars, and phil- 
anthropists. 

It must not be forgotten that the army 
is originally composed of picked men, 
while the general community Includes not 
only the imperfect, diseased, and weak 
that belong to itself, but also those who 
are rejected from the army. If, then, the 
conditions, circumstances, and habits of 
both were equally favorable, there would 
be less sickness and a lower rate of mor- 
tality among the soldiers than among men 
of the same ages at home. But if in the 
army there should be found more sick- 
ness and death than In the community at 
home, or even an equal amount, it is mani- 
festly chargeable to the presence of more 
deteriorating and destructive influences 
In the military than in civil life. 

SICKNESS AND MORTALITY IN CIVIL 
LIFE. 

The amount of sickness among the 
people at home is not generally recog- 



1862.] 



Sanitary Condition of the Army. 



467 



nized, still less is it carefully measured 
and recorded. But the experience and 
calculations of tlie Friendly Societies of 
Great Britain, and of other associations 
for Health -Assurance there and else- 
where, afford sufficient data for deter- 
mining the proportion of time lost in 
sickness by men of various ages. These 
Friendly Societies are composed mainly 
of men of the working-classes, from which 
most of the soldiers of the British army 
are drawn. 

According to the calculations and ta- 
bles of Mr. Ansel, in his work on " Friend- 
ly Societies," the men of the army-ages, 
from 20 to 40, in the working-classes, lose, 
on an average, five days and six-tenths 
of a day by sickness in each year, which 
will make one and a half per cent, of the 
males of this age and class constantly sick. 
Mr. Nelson's calculations and tables, in his 
" Contributions to Vital Statistics," make 
this average somewhat over seven days' 
yearly sickness, and one and ninety-two 
hundredths of one per cent, constantly 
sick. These were the bases of the rates 
adopted by the Health -Assurance com- 
panies in New England, and their expe- 
rience shows that the amount of sickness 
in these Northern States is about the same 
as, if not somewhat greater than, that in 
Great Britain, among any definite num- 
ber of men. 

The rate of mortality is more easily 
ascertained, and is generally calculated 
and determined in civilized nations. This 
rate, among all classes of males, between 
20 and 40 years old, in England and 
Wales, is .92 per cent. : that is, 92 will die 
out of 10,000 men of these ages, on an 
average, in each year ; but in the health- 
iest districts the rate is only 77 in 10,000. 
The mortality among the males of Massa- 
chusetts, of the same ages, according to 
Mr. Elliott's calculations, is 1.11 per cent, 
or 111 In 10,000. This maybe safely as- 
sumed as the rate of mortality in all New 
England. That of the Southern States 
is somewhat greater. 

These rates of sickness and death — 
one and a half or one and ninety-two 
hundredths per cent, constantly sick, and 



seventy-seven to one hundred and eleven 
dying, in each year, among ten thousand 
hving — may be considered as the pro- 
portion of males, of the army-ages, that 
should be constantly taken away from 
active labor and business by illness, and 
that should be annually lost by death. 
Whether at home, amidst the usually 
favorable circumstances and the average 
comforts, or in the army, under privation 
and exposure, men of these ages may be 
presumed to be necessarily subject to this 
amount, at least, of loss of vital force and 
life. And these rates may be adopted as 
the standard of comparison of the sanita- 
ry Influences of civil and military life. 

SICKNESS AND MORTALITY OF THE 
ARMY IN PEACE. 

Soldiers are subject to different in- 
fluences and exposures, and their waste 
and loss of life differ. In peace and war. 
In peace they are mostly stationary, at 
posts, forts, and in cantonments. They 
generally live in barracks, with fixed hab- 
its and sufficient means of subsistence. 
They have their regular supplies of food 
and clothing and labor, and are protect- 
ed from the elements, heat, cold, and 
storms. They are seldom or never sub- 
jected to privation or excessive fatigue. 
But in war they are In the field, and sleep 
in tents which are generally too full and 
often densely crowded. Sometimes they 
sleep In huts, and occasionally In the open 
air. They are liable to exposures, hard- 
ships, and privations, to uncertain sup- 
plies of food and bad cookery. 

The report of the commission appoint- 
ed by the British Government to inquire 
Into the sanitary condition of the army 
shows a remarkable and unexpected de- 
gree of mortality among the troops sta- 
tioned at home under the most favorable 
circumstances, as well as among those 
abroad. The Foot-Guards are the very 
elite of the whole army ; they are the most 
perfect of the faultless In form and in 
health. They are the pets of the Govern- 
ment and the people. They are station- 
ed at London and Windsor, and lodged in 



468 



Sanitary Condition of the Army. 



[October, 



magnificent barracks, apparently ample 
for their accommodation. They are cloth- 
ed and fed with extraordinary care, and 
are supposed to have every means of 
health. And yet their record shows a sad 
difference between their rate of mortal- 
ity and that of men of the same ages in 
civil life. A similar excess of mortality 
■was found to exist among all the home- 
army, which includes many thousand sol- 
diers, stationed in various towns and pla- 
ces throughout the kingdom. 

The following table exhibits the annual 
mortality in these classes.* 

DEATHS IN 10,000. 







»^ 


a 




O 


o 


o 


> 


<_ 


o 


B 


cr? 


^ 


6 


1 


? 


BS 


!= 


> 




P 


» 


•-1 






"-J 


B 






^ 


'< 


20 to 25 


84 


216 


170 


25 to 30 


92 


211 


183 


30 to 35 


102 


195 


184 


35 to 40 


116 


224 


193 



Through the fifteen years from 1839 to 
1853 inclusive, the annual mortality of all 
the army, excepting the artillery, engi- 
neers, and West India and colonial corps, 
was 330 among 10,000 living; while that 
among the same number of males of the 
army-ages, in all England and Wales, was 
92, and in the healthiest districts only 77.f 

There is no official account at hand 
of the general mortality in the Russian 
army on the peace-establishment ; yet, ac- 
cording to Boudin, in one portion, con- 
sisting of 192,834 men, 144,352 had been 
sick, and 7,541, or 38 per 1,000, died in 
one year. % 

The Prussian army, with an average 
of 150,582 men, lost by death, during the 
ten years 1829 to 1838, 1,975 in each 
year, which is at the rate of 13 per 1,000 
living. § 

The mortality of the Piedmontese ar- 

* Report on the Sanitary Condition of the 
British Army, 

t Ibid. 

X Traite de GeograjMe et de Statistique Medi- 
cnles, Tom. II. p. 239. 

§ Ibid. p. 286. 



my, from 1834 to 1843 inclusive, was 158 
in 10,000, while that of the males at 
home was 92 in the same number living. 

From 1775 to 1791, seventeen years, 
the mortaUty among the cavalry was 
181, and among the infantry 349, out of 
10,000 living ; but in the ten years from 
1834 to 1843 these rates were only 108 
and 215.* 

Colored troops are employed by the 
British Government in all their colonies 
and possessions in tropical climates. The 
mortality of these soldiers is known, and 
also that of the colored male civilians in 
the East Indies and in the West- India 
Islands and South-American Provinces. 
In four of these, the rate of mortality is 
higher among the male slaves than among 
the colored soldiers ; but in all the oth- 
ers, this rate is higher in the army. In 
all the West-Indian and South- American 
possessions of Great Britain, the average 
rate of deaths is 25 per cent, greater 
among the black troops than among the 
black males of all ages on the plantations 
and in the towns. The soldiers are of 
the healthier ages, 20 to 40, but the civil- 
ians include both the young and the old : 
if these could be excluded, and the com- 
parison made between soldiers and labor- 
ers of the same ages, the difference in fa- 
vor of civil pursuits would appear much 
greater. 

Throughout the world, where the ar- 
mies of Great Britain are stationed or 
serve, the death-rate is greater among 
the troops than among civilians of the 
same races and ages, except among the 
colored troops in Tobago, Montserrat, 
Antigua, and Granada in America, and 
among the Sepoys in the East Indies, f 

In the army of the United States, 
during the period from 1840 to 1854, 
not including the two years of the Mexi- 
can War, there was an average of 9,278 
men, or an aggregate of 120,622 years 
of service, equal to so many men serv- 
ing one year. Among these and dur- 

* Traite de Geoc/raphie etde Statistique Medi- 
cates, Tom. II. p. 284. 

t Report on the Sanitary Condition of the 
Bntish Ai-my. 



1862.] 



Sanitary Condition of the Army. 



469 



ing this period, there were 342,107 cases 
of sickness reported by tlie surgeons, 
and 3,416 deaths from disease, show- 
ing a rate of mortality of 2.83 per cent., 
or two and a half times as gi-eat as 
that among the males of Massachusetts 
of the army -ages, and three times as 
great as that in England and Wales. 
The attacks of sickness average almost 
three for each man in each year. This 
is manifestly more than that which falls 
upon men of these ages at home.* 

SICKNESS AND MORTALITY OF THE 
ARMY IN WAR. 

Thus far the sickness and mortality 
of the army in time of peace only has 
been considered. The experience of 
war tells a more painful story of the dan- 
gers of the men engaged in it. Sir John 
Pringle states, that, in the British armies 
that were sent to the Low Countries and 
Germany, in the years 1743 to 1747, a 
great amount of sickness and mortality 
prevailed. He says, that, besides those 
■who were suffering from wounds, " at some 
periods more than one-fifth of the army 
were in the hospitals." *' One regiment 
had over one-half of its men sick." " In 
July and August, 1743, one-half of the 
army had the dysentery." " In 1 747, four 
battalions," of 715 men each, "at South 
Beveland and Walcheren, both in field 
and in quarters, were so very sickly, thatj 
at the height of the epidemic, some of 
these corps had but one hundred men fit 
for duty ; six-sevenths of their numbers 
were sick."f "At the end of the cam- 
paign the Royal Battalion had but four 
men who had not been ill." And " when 
these corps went into winter -quarters, 
their sick, in proportion to their men fit 
for duty, were nearly as four to one." % 
In 1 748, dysentery prevailed. " In one 
regiment of 500 men, 150 were sick at 
the end of five weeks ; 200 were sick af- 

* Medical Statistics U. S. Army, 1839-54, 
p. 491, etc. 

t Observations on the Diseases of the Army, 
p. 51. 

\ lb., p. 53. 



ter two months ; and at the end of the 
campaign, they had in all but thirty who 
had never been ill." " In Johnson's reg- 
iment sometimes one-half were sick ; and 
in the Scotch Fusileers 300 were ill at 
one time."* 

The British army in Egypt, in 1801, 
had from 103 to 261 and an average of 
182 sick in each thousand ; and the French 
army had an average of 125 in 1,000, 
or one-eighth of the whole, on the sick- 
list, t 

In July, 1809, the British Government 
sent another army, of 39,219 men, to the 
Netherlands. They were stationed at 
Walcheren, which was the principal seat 
of the sickness and sufiering of their pre- 
decessors, sixty or seventy years before. 
Fever and dysentery attacked this sec- 
ond army as they had the first, and with 
a similar virulence and destructiveness. 
In two months after landing, 

Sept. 13, 7,626 were on the sick-list. 
" 19, 8,123 " " 

" 21, -6,684 » •" 

" 23, 9,046 " " 

In ninety-seven days 12,867 were sent 
home sick ; and on the 2 2d of October 
there were only 4,000 effective men left 
fit for duty out of this army of about 40,000 
healthy men, who had left England within 
less than four months. On the 1st of Feb- 
ruary of the next year, there were 11,513 
on the sick-list, and 15,570 had been lost 
or disabled. Between January 1st and 
June of the same year, (1810,) 36,500 
were admitted to the hospitals, and 8,000, 
or more than 20 per cent., died, which is 
equal to an annual rate of 48 per cent, 
mortality. 

The British army in Spain and Portu- 
gal suffered greatly through the Penin- 
sular War, from 1808 to 1814. During 
the whole of that period, there was a con- 
stant average of 209 per 1,000 on the sick- 
list, and the proportion was sometimes 
swelled to 330 per 1,000. Through the 

* Observations on the Diseases of the Army,. 
p. 59. 

t London Statistical Journal, Vol. XIX. p. 
247. 



470 



Sanitary Condition of the Army. 



[October, 



forty-one months ending May 25th, 1814, 
"vvith an average of 61,511 men, there was 
an average of 13,815 in the hospitals, 
Tvhich is 22.5 per cent. ; of these only 
one-fifteenth, or 1.5 per cent, of the whole 
army, were laid up on account of injuries 
in battle, and 21 per cent, were disabled 
by diseases. From these causes 24,930 
died, which is an annual average of 7,296, 
or a rate of 11.8 per cent, mortality.* 

No better authority can be adduced, 
for the condition of men engaged in the 
actual service of war, than Lord Welling- 
ton. On the 14th of November, 1809, 
he wrote from his army in Spain to Lord 
Liverpool, then at the head of the British 
Government, — " In all times and places 
the sick-list of the army amounts to ten 
per cent of all." f He seemed to consid- 
er this the lowest attainable rate of sick- 
ness, and he hoped to be able to reduce 
that of his own army to it : this is more 
than five times as great as the rate of 
sickness among male civilians of the army- 
ages. The sickness in Lord Wellington's 
army, at the moment of writing this de- 
spatch, was fifteen per cent., or seven and 
a half times as great as that at home. 

In the same Peninsular War, there was 
of the sick in the French army a con- 
stant average of 136 per 1,000 in Spain, 
and 146 per 1,000 in Portugal. Mr. Ed- 
monds says, that, just before the Battle 
of Talavera, the French army consisted 
of 275,000 men, of whom 61,000, or 22.2 
per cent., were sick.J Lord Wellington 
wrote, Sept. 19, 1809, that the French ar- 
my of 225,000 men had 30,000 to 40,000 
sick, which is 13.3 to 17.7 per cent. The 
French army in Portugal had at one 
time 64 per 1,000, and at another 235 per 
1,000, and an average of 146 per 1,000, in 
the hospitals through the war. 

The British army that fought the Bat- 
tle of Waterloo, in 1815, had an average 
of 60,992 men, through the campaign of 
four months, June to September ; of these, 

" * Edmonds ia London Lancet, Vol. XXXVI. 
p. 143. 

t Despatches. 

X Edmonds in London Lancet, Vol. XXXVI. 
p. 145. 



there was an average of 7,909, or 12.9 per 
cent., in the hospitals.* 

The British legion that went to Spain 
in 1836 consisted of 7,000 men. Of 
these, 5,000, or 71 per cent, were admit- 
ted into the hospitals in three and a half 
months, and 1,223 died in six months. 
This is equal to an annual rate of almost 
two and a half, 2.44, attacks for each man, 
and of 34.9 per cent, mortality, f 

" Of 115,000 Prussians who invaded 
Turkey in 1828 and 1829, only 10,000 or 
15,000 ever repassed the Pruth. The 
rest died there of intermittent fevers, 
dysenteries, and plague." " From May, 
1828, to February, 1829, 210,108 patients 
were admitted into the general and regi- 
mental hospitals." "In October, 1828, 
20,000 entered the general hospitals." 
" The sickness was very fatal." " More 
than a quarter of the fever-patients died." 
" 5,509 entered the hospitals, and of these, 
3,959 died in August, 1829, and only 614 
ultimately recovered." " At Brailow the 
plague attacked 1,200 and destroyed 774." 
" Dysentery was equally fatal." " In the 
march across the Balkan, 1,000 men died 
of diarrhoea, fever, and scurvy." " In 
Bulgaria, during July, 37,000 men were 
taken sick." " At Adrlanople a vast bar- 
rack was taken for a hospital, and in three 
days 1,616 patients were admitted. On 
the first of September there were 3,666, 
and on the 15th, 4,646 patients in the 
house. This was one-quarter of all the 
disposable force at that station." " In Oc- 
tober, 1,300 died of dysentery ; and at the 
end of the month there were 4,700 in the 
hospitals." " In the whole army the loss 
to the Russians in the year 1829 was at 
least 60,000 men."$ 

CRIMEAN WAR. 

In 1854, twenty-five years after this 
fatal experience of the Russian army in 

* Edmonds in London Lancet, Vol. XXXVI. 
p. 148. 

t Ih., p. 219. 

{ Boudin, Traite de Geographie et de Statis- 
iique Miidicales, Tom. II. p. 289, etc., quoted 
by him from Major Moltka. 



1862.] 



Sanitary Condition of the Army. 



471 



Bulgaria, the British Government sent 
an army to the same province, where the 
men -were exposed to the same diseases 
and suffered a similar depreciation of 
vital force in sickness and death. For 
two years and more they struggled with 
these destructive influences in their own 
camps, in Bulgaria and the Crimea, with 
the usual result of such exposures in the 
waste of life. From April 10, 1854, to 
June 30, 1856, 82,901 British soldiers 
were sent to the Black Sea and its coasts ; 
and through these twenty-six and two- 
thirds months the Bi-itish army had an 
average of 34,559 men engaged in that 
" War in the East " with Russia. From 
these there were furnished to the gen- 
eral and regimental, the stationary and 
movable hospitals 218,952 cases: 24,084, 
or 11 per cent, of these patients were 
wounded or injured in battle, and 194,- 
868, or 89 per cent., suffered from the 
diseases of the camp. This is equal to 
an annual average of two and a half at- 
tacks of sickness for each man. The 
published reports give an analysis of on- 
ly 162,123 of these cases of disease. Of 
these, 110,673, or 68 per cent., were of 
the zymotic class, — fevers, dysenteries, 
scurvy, etc., which are generally sup- 
posed to be due to exposure and priva- 
tion, and other causes which are subject 
to human control. During the two years 
ending with March, 1856, 16,224 died of 
diseases, of which 14,476 were of the zy- 
motic or preventable class, 2,755 were 
killed in battle, and 2,019 died of wounds 
and injuries received in battle. The an- 
nual rate of mortality, from all diseas- 
es, was 23 per cent. ; from zymotic dis- 
eases, 21 per cent. ; from battle, 6.9 per 
cent. The rate of sickness and mortality 
varied exceedingly in different months. 
In April, May, and June, 1854, the deaths 
were at the annual rate of 8.7 per 1,000 ; 
in July, 159 per 1,000; in August and 
September, 340 per 1,000; in December, 
this rate again rose and reached 679 per 
1,000 ; and in January, 1855, owing to the 
great exposures, hardships, and privations 
in the siege, and the very imperfect means 
of sustenance and protection, the mortal- 



ity increased to the enormous rate of 1,142 
per 1,000, so that, if it had continued un- 
abated, it would have destroyed the wholo 
army in ten and a half months.* 

AMERICAN ARMY, 1812 TO 1814. 

We need not go abroad to find proofs 
of the waste of life in military camps. 
Our own army, in the war with Great 
Britain in 1812-14, suffered, as the Euro- 
pean armies have done, by sickness and 
death, far beyond men in civil occupa- 
tions. There are no comprehensive re- 
ports, published by the Government, of 
the sanitary condition and history of the 
army on the Northern frontier during 
that war. But the partial and fragmen- 
tary statements of Dr. Mann, in his 
" Medical Sketches," and the occasional 
and apparently incidental allusions to the 
diseases and deaths by the commanding- 
officers, in their letters and despatches to 
the Secretary of War, show that sickness 
was sometimes fearfully pi-evalent and 
fatal among our soldiers. Dr. Mann says : 
" One regiment on the frontier, at one 
time, counted 900 strong, but was reduced, 
by a total want of a good police, to less 
than 200 fit for duty." " At one period 
more than 340 were in the hospitals, and, 
in addition to this, a large number were 
reported sick in camp." f " The aggre- 
gate of the army at Fort George and its 
dependencies was about 5,000. From an 
estimate of the number sick in the gen- 
eral and regimental hospitals, it was my 
persuasion that but little more than half 
of the army was capable of duty, at one 
period, during the summer months":!: of 
1813. "During the month of August 
more than one-third of the soldiers were 
on the sick-reports." § Dr. Mann quotes 
Dr. Lovell, another army -surgeon, who 
says, in the autumn of 1813 : "A morn- 
ing report, now before me, gives 75 sick, 
out of a corps of 160. The several regi- 
ments of the army, in their reports, ex- 

* Report on the Sanitary Condition of the 
British Army, p. 524. 

t Medical S/cetches, p. 39. 

t ]b., p. 204. § lb., p. 66. 



472 



Sanitary Condition of the Army. 



[October, 



liibit a proportional number unfit for du- 
ty." * Dr. Mann states that " the troops 
at Burlington, Vt., in the winter of 1812- 
13, did not number over 1,600, and the 
deaths did not exceed 200, from the last 
of November to the last of February." j- 
But Dr. Gallup says : " The whole num- 
ber of deaths Is said to be not less than 
700 to 800 in four months," and " the 
number of soldiers stationed at this en- 
campment [Burlington] was about 2,500 
to 2,800." t According to Dr. Mann's 
statement, the mortality was at the annual 
rate of 50 per cent. ; and according to that 
of Dr. Gallup, it was at the rate of 75 to 
96 per cent. This is nearly equal to the 
severest mortality in the Crimea. 

General William H. Harrison, writing 
to the Secretary of War from the borders 
of Lake Erie, Aug. 29, 1813, says: "You 
can form some estimate of the deadly 
effects of the immense body of stagnant 
■water with which the vicinity of the lake 
abounds, from the state of the troops 
at Sandusky. Upwards of 90 are this 
morning reported sick, out of about 220." 
This is a rate of over 40 per cent. 
" Those at Fort Meigs are not much bet- 
ter." § 

General Wilkinson wrote from Fort 
George, Sept. 16, 1813: "We count, on 
paper, 4,600, and could show 3,400 com- 
batants " ; that is, 25 per cent, and more 
are sick. " The enemy, from the best in- 
formation we have, have about 3,000 on 
paper, of whom 1,400," or 46.6 per cent., 
" are sick." || 

MEXICAN WAR. 

There was a similar waste of life 
among our troops in the Mexican War. 
There is no published record of the num- 
ber of the sick, nor of their diseases. But 
the letters of General Scott and General 
Taylor to the Secretary of War show 
that the loss of effective force in our ar- 

* MecKcal Sketches, p. 119. 

t Jb., p. 199. 

J On Epidemics, p. 70. 

§ United States Documents, 1814. 

II lb., 1814. 



my was at times very great by sickness 
in that war. 

General Scott wrote : — 

" Puehla, July 25, 1847. 

" May 30, the number of sick here was 
1,017, of effectives 5,820." 

" Since the arrival of General Pillow, 
we have effectives (rank and file) 8,061, 
sick 2,215, beside 87 officers under the 
latter head." * 

Again : — 

" Mexico, Dec. 5, 1847. 

" The force at Chapultepcc fit for duty 
is only about 6,000, rank and file; the 
number of sick, exclusive of officers, be- 
ing 2,041." -f 

According to these statements, the pro- 
portions of the sick were 17.4 to 27.4 and 
24.7 per cent, of all in these corps at tho 
times specified. 

General Taylor wrote : — 

" Camp near Monterey, July 27, 1847. 

" Great sickness and mortality have 
prevailed among the volunteer troops in 
front of Saltillo." % 

August lOth, he said, that " nearly 23 
per cent, of the force present was disabled 
by disease." 

The official reports show only the num- 
ber that died, but make no distinction as 
to causes of death, except to separate the 
deaths from wounds received in battle 
' from those from other causes. 

During that war, 100,454 men were 
sent to Mexico from the United States. 
They were enlisted for various periods, 
but served, on an average, thirteen 
months and one day each, making a total 
of 109,104 years of military service ren- 
dered by our soldiers in that Avar. The 
total loss of these men was 1,549 killed 
in batde or died of wounds, 10,986 died 
from diseases, making 12,535 deaths. Be- 
sides these, 12,252 were discharged for. 
disability. The mortality from disease 
was almost equal to the annual rate of 
11 per cent., which is about ten times as 

* Executive Documents, U. S., 1847-48, Vol. 
VII. p. 1013. 



t Ih., p. 1033. 



t 11., p. 1185. 



1862.] 



Sanitary Condition of the Army. 



473 



great as that of men in ordinary civil 
life at home. 



SICKNESS IN THE PRESENT UNION 
ARMY. 

There are not as yet, and for a long 
time there cannot be, any full Govern- 
ment reports of the amount and kind of 
sickness in the present army of the Unit- 
ed States. But the excellent reports of 
the inquiries of the Sanitary Commis- 
sion give much important and trustwor- 
thy information in respect to these mat- 
ters. Most of the encampments of all the 
corps have been examined by their in- 
spectors ; and their returns show, that the 
average number sick, during the seven 
months ending wifeh February last, was, 
among the troops who were recruited in 
New England 74.6, among those from 
the Middle States 56.6, and, dunng six 
months ending with January, among those 
from the Western States 104.3, in 1,000 
men. From an examination of 217 regi- 
ments, during two months ending the 
middle of February, the rate of sickness 
among the troops in the Eastern Sanitary 
Department was 74, in the Central De- 
partment, Western Virginia and Ohio, 
90, and in the Western, 107, in 1,000 
men. The average of all these regiments 
was 90 in 1,000. The highest rate in 
Eastern Virginia was 281 per 1,000, in 
the Fifth Vermont ; and the lowest, 9, in 
the Seventh Massachusetts. In the Cen- 
tral Department the highest was 260, in 
the Forty-First Ohio ; and the lowest, 1 7, 
in the Sixth Ohio. In the Western De- 
partment the highest was 340, in the 
Forty -Second Illinois; and the lowest, 
15, in the Thirty- Sixth Illinois. 

On the 22d of Febi-uary, the number 
of men sick in each 1,000, in the several 
divisions of the Army of the Potomac, 
was ascertained to be, — 

Keyes's, 30.3 

Sedgwick's, 32.0 

Hooker's, 43.7 

McCall's 44.4 

Banks's, 45.0 

Porter's 46.4 



Blenker's, .... 


47.7 


McDowell's, . 


. 48.2 


Heintzehiiaii's, . 


49.0 


Franklin's, 


. 54.1 


Dix's, 


71.8 


United States Regulars, . 


. 76.0 


Sumner's, .... 


77.5 


Smith's, .... 


. 81.6 



Casey's, . . . . . 87.6* 

Probably there has been more sickness 
in all the armies, as they have gone far- 
ther southward and the warm season has 
advanced. This would naturally be ex- 
pected, and the fear is strengthened by 
the occasional reports in the newspapers. 
Still, taking the trustworthy reports hei'ein 
given, it is manifest that our Union army 
is one of the healthiest on record ; and yet 
their rate of sickness is from three to five 
times as great as that of civilians of their 
own ages at home. Unquestionably, this 
better condition of our men is due to the 
better intelligence of the age and of our 
people, — especially in respect to the dan- 
gers of the field and the necessity of prop- 
er provision on the part of the Govern- 
ment and of self-care on the part of the 
men, — to the wisdom, labors, and com- 
prehensive watchfulness of the Sanitary 
Comnnssion, and to the universal sympa- 
thy of the men and women of the land, 
who have given their souls, their hands, 
and their money to the work of lessen- 
ing the discomforts and alleviating the 
sutferings of the Army of Freedom. 

OTHER LIGHTER AND UNRECORDED 
SICKNESS. 

The records and reports of the sick- 
ness in the army do not include all the 
depreciations and curtailments of life and 
strength among the soldiers, nor all the 
losses of effective force which the Govern- 
ment suffers through them, on account of 
disease and debility. These records con- 
tain, at best, only such ailments as are of 
sufficient importance to come under the 
observation of the surgeon. But there 
are manifold lighter physical disturbances, 
which, though they neither prostrate the 

* MS. Letter of Mr. Elliott, Actuary of tlie 
Sanitary Commission. 



474 



Sanitary Condition of the Army. 



[October, 



patient, nor even cause liim to go to the 
hospital, yet none the less certainly unfit 
him for labor and duty. Of the regiment 
referred to by Dr. Mann, and already ad- 
duced in this article, in which 700 were 
unable to attend to duty, 340 were in the 
hospital under the surgeon's care, and 360 
were ill in camp. It is probable that a 
similar, though smaller, discrepancy often 
exists between the surgeon's records and 
the absentees from parades, guard-duty, 
etc. 

It is improbable, and even impossible, 
that complete records and reports should 
always be made of all who are sick and 
unfit for duty, or even of all who come 
under the surgeon's care. Sir John Hall, 
principal Medical Officer of the British 
army in the Crimea, says that there were 
"218,952 admissions into hospitah" * 
" The general return, showing the pri- 
mary admissions into the hospitals of the 
army in the East, from the 10th April, 
1854, to the 30th June, 1856, gives only 
162,123 cases of all kinds." f But an- 
other Government Report states the ad- 
missions to be 1 6 2,6 73. t Miss Nightin- 
gale says, " There was, at first, no system 
of registration for general hospitals, for all 
were burdened with work beyond their 
strength." § Dr. Mann says, that, in the 
War of 1812, " no sick-records were found 
in the hospital at Burlington," one of the 
largest depositories of the sick then in the 
country. " The hospital-records on the 
Niagara were under no order." || It could 
hardly have been otherwise. The regi- 
mental hospitals then, as frequently must 
be the case in war, were merely extem- 
porized shelters, not conveniences. They 
were churches, houses, barns, shops, sheds, 
or arky building that happened to be with- 
in reach, or huts, cabins, or tents sudden- 
ly created fur the purpose. In these all 
the surgeons' time, energy, and resources 

* Report cm the Sanitary Condition of the Brit- 
ish Army, p. 180. 
t lb., 525. 

I Medical and Surgical ITistory of the War 
in the East, Vol. II. p. 252. 

§ Report on the Sanitary Condition of the Brit- 
ish Army, p. 377. 

II Medical Sketches, p. 246. 



were expended in making their patients 
comfortable, in defending them from cold 
and storm, or from suffering in their 
crowded rooms or shanties. They were 
obliged to devote all their strength to 
taking care of the present. They could 
take little account of the past, and were 
often unable to make any record for the 
future. They could not do this for those 
under their own immediate eye in the 
hospital ; much less could they do it for 
those who remained in their tents, and 
needed little or no medical attention, 
but only rest. Moreover, the exposures 
and labors of the campaign sometimes 
diminish the number and force of the 
surgeons as well as of the men, and re- 
duce their strength at the very moment 
when the greatest demand is made for 
their exertions. Dr. Mann says, " Tlie 
sick in the hospital were between six and 
seven hundred, and there were only three 
surgeons present for duty." " Of seven 
surgeons attached to the hospital depart- 
ment, one died, three were absent by rea- 
son of indisposition, and the other three 
were sick."* Fifty-four surgeons died in 
the Russian army in Turkey in the sum- 
mer of 1828. " At Brailow, the pestilence 
spared neither surgeons nor nurses." f 
Sir John Hall says, " The medical offi- 
cers got sick, a great number went away, 
and we were embarrassed." " Thirty per 
cent, were sometimes sick and absent" 
from their posts in the Crimea. $ Seven- 
ty surgeons died in the French army in 
the same war. It is not reasonable, then, 
to suppose that all or nearly all the cas- 
es of sickness, whether in hospital or 
in camp, can be recorded, especially at 
times when they are the most abundant. 
Nor do the cases of sickness of every 
sort, grave and light, recorded and un- 
recorded, include all the depressions of 
vital energy and all the suspensions and 
loss of effective force in the army. When- 
ever any general cause of depression 

* Medical Sketches, p. 66. 

t Boudin, Traite de Geographic et de Sta- 
tislique Medicales, Tom. II., p. 289. 

I Report on the Sanitary Condition of the Brit- 
ish Army, p. 180. 



1862.] 



Sanitary Condition of the Army. 



475 



■weighs upon a body of men, as fatigue, 
cold, storm, privation of food, or malaria, 
it vitiates the power of all, in various de- 
gi'ees and with various results ; the weak 
and susceptible are sickened, and all lose 
some force and are less able to labor and 
attend to duty. No account is taken, 
none can be taken, of this discount of the 
general force of the army ; yet it is none 
the less a loss of strength, and an imped- 
iment to the execution of the purposes of 
the Government. 



INVALIDING. 

The loss of force by death, by sickness 
in hospital and camp, and by temporary 
depression, is not all that the army is sub- 
ject to. Those who are laboring under 
consumption, asthma, epilepsy, insanity, 
and other Incurable disorders, and those 
whose constitutions are broken, or with- 
ered and reduced below the standard of 
military requirement, are generally, and 
by some Governments always, discharged. 
These pass back to the general communi- 
ty, where they finally die. By this pro- 
cess the army is continually sifting out 
its worst lives, and at the same time it 
fills their places with healthy recruits. It 
thus keeps up its average of health and 
diminishes its rate of mortality ; but the 
sum and the rates of sickness and mor- 
tality in the community are both there- 
by increased. 

During the Crimean War, 17.34 per 
cent, were invalided and sent home from 
the British army, and 21 per cent, from 
the French army, as unable to do military 
service. By this means, 11,994* British 
and 65,069 f .French soldiers were lost to 
their Governments. The army of the 
United States, in the Mexican War, dis- 
charged and sent home 12,252 men, or 12 
per cent, of the entire number engaged 
in that war, on account of disability. 

The causes of this exhaustion of per- 
sonal force are manifold and various, and 

* Medical and Surgical Ilistory of die British 
Army in the East, Vol. II. p. 227. 

t British and Foreign Medical and Surgical 
Journal, Vol. XXI. 



SO generally present that the number and 
proportion of those who are thus hope- 
lessly reduced below the degree of effi- 
cient military usefulness, in the British 
army, has been determined by observa- 
tion, and the Government calculates the 
rate of the loss which will happen in 
this way, at any period of service. Out 
of 10,000 men enlisted in their twenty- 
first year, 718 will be invalided during 
the first quinquennial period, or before 
they pass their twenty-fifth year, 539 
in the second, 673 In the third, and 854 
in the fourth, — making 2,784, or more 
than one-quarter of the whole, dischar- 
ged for disability or chronic ailment, be- 
fore they complete their twenty years of 
military service and their forty years of 
life. 

It is further to be considered, that, dur- 
ing these twenty years, the numbers are 
diminishing by death, ancf thus the ratio 
of the enfeebled and invalided is increas- 
ed. Out of 10,000 soldiers who survive 
and remain in the army in each succes- 
sive quinquennial period, 768 will be in- 
valided in the first, 680 in the second, 
1,023 in the third, and 1,674 in the 
fourth. In the first year the ratio is 
181, in the fifth 129, in the tenth 165, 
in the fifteenth 276, and in the twen- 
tieth 411, among 10,000 surviving and 
remaining. 

The depressing and exhaustive force 
of military life on the soldiers is gradual- 
ly accumulative, or the power of resist- 
ance gradually wastes, from the beginning 
to the end of service. There is an ap- 
parent exception to this law in the fact, 
that, in the British army, the ratio of 
those who were invalided was 181 in 
10,000, but diminished, in the second, , 
third, and fourth years, to 129 In the 
fifth and sixth, then again rose, through 
all the succeeding years, to 411 In the 
twentieth. The experience of the Brit- 
ish army, In this respect, is corroborated 
by that of ours in the Mexican War. 
From the old standing army 502, from 
the additional force recently enlisted 548, 
and from the volunteers 1,178, in 10,000 
of each, were discharged on account of 



476 



Sanitary Gondiiion of the Army. 



[October, 



disability. Some part of this great dif- 
ference between the regulars and volun- 
teers is doubtless due to the well-known 
fact, that the latter were originally en- 
listed, in part at least, for domestic train- 
ings, and not for the actual service of 
war, and therefore were examined with 
less scrutiny, and included more of the 
weaker constitutions. 

The Sanitary Commission, after in- 
specting two hundred and seventeen reg- 
iments of the present army of the United 
States, and comparing the several corps 
with each other in respect of health, came 
to a similar conclusion. They found that 
the twenty-four regiments which had the 
least sickness had been in service one 
hundred and forty days on an average, 
and the twenty-four regiments which had 
the most sickness had been in the field 
only one hundred and eleven days. The 
Actuary adds^ in explanation, — "The 
difference between the sickness of the 
older and newer regiments is probably 
attributable, in part, to the constant weed- 
ing out of the sickly by discharges from 
' the service. The fact is notorious, that 
medical inspection of recruits, on enlist- 
ment, has been, as a rule, most imperfectly 
executed ; and the city of Washington is 
constantly thronged with invalids awaiting 
their discharge-papers, who at the time of 
their enlistment were physically unfit for 
service."* In addition to this, it must 
be remembered, that, although all re- 
cruits are apparently perfect in form and 
free from disease when they enter the 
army, yet there may be differences in 
constitutional force, which cannot be de- 
tected by the most careful examiners. 
Some have more and some have less 
power of endurance. But the military 
burden and the work of war are arranged 
and determined for the strongest, and, of 
course, break down the weak, who retire 
in disability or sink in death. 

GENERAL VITAL BEPRESSIOX. 

Two causes of depression operate, to 
a considerable degree in peace and to a 
* MS. Letter of Mr. Elliott. 



very great degree in war, on the soldier, 
and reduce and sicken him more than 
the civilian. His vital force is not so 
well sustained by never-failing supplies 
of nutritious and digestible food and reo-u- 
lar nightly sleep, and his powers are more 
exhausted in hardships and exposures, in 
excessive labors and want of due rest 
and protection against cold and heat, 
storms and rains. Consequently the ar- 
my suffers mostly from diseases of depres- 
sion, — those of the typhoid, adynamic, 
and scorbutic types. McGrigor says, 
that, in the British army in the Peninsula, 
of 1 76,007 cases treated and recorded by 
the surgeons, 68,894 were fevers, 23,203 
diseases of the bowels, 12,167 ulcers, and 
4,027 diseases of the lungs.* In the Brit- 
ish hospitals in the Crimean War, 30 per 
cent, were cholera, dysenterj', and diar- 
rhoea, 19 per cent, fevers, 1.2 per cent, 
scurvy, 8 per cent, diseases of the lungs, 
8 per cent, diseases of the skin, 3.3 per 
cent, rheumatism, 2.5 per cent, diseases 
of the brain and nervous system, 1.4 per 
cent, frost-bite or mortification produced 
by low vitality and chills, 13, or one in 
12,000, had sunstroke, 257 had the itch, 
and 68 per cent, of all were of the zymot- 
ic class,f which are considered as prin- 
cipally due to privation, exposure, and 
personal neglect. The deaths from these 
classes of causes were in a somewhat sim- 
ilar proportion to the mortality from all 
stated causes, — being 58 per cent, from 
cholera, dysentery, and diarrhoea, and 1 
per cent, from all other disorders of the 
digestive organs, 19 per cent, from fevers, 
3.6 per cent, from diseases of the lungs, 
1.3 per cent, from rheumatism, 1.3 per 
cent, from diseases of the bcain and ner- 
vous system, and 79 per cent, from those 
of the zymotic class. The same classes 
of disease, with a much larger proportion 
of typhoid pneumonia, prostrated and de- 
stroyed many in the American army in 
the War of 1812. 

* Medico- Cliirurgical Transactions, Vol. VI. 
p. 478, etc. 

t Report on the Sanitary Condition of the 
British Army, p. 525. — Medical and Surgical 
History of the War in the East. 



1862.] 



Sanitary Condition of the Army. 



477 



In paper No. 4^, p. 54, of the Sanitary 
Commission, is a report of the diseases that 
occurred in forty-nine regiments, while 
under inspection about forty days each, 
between July and October, 1861. 27,526 
cases were reported ; of these 67 per 
cent, were zymotic, 41 per cent, diseases 
of the digestive organs, 22 per cent, fe- 
vers, 7 per cent, diseases of the lungs, 
5 per cent, diseases of the brain. Among 
males of the army-ages the proportions of 
deaths from these classes of causes to those 
from all causes were, in Massachusetts, in 
1859, zymotic 15 per cent., diseases of di- 
gestive organs 3.6 per cent., of lungs 50 
per cent, fevers 9 per cent, diseases of 
brain 4.6 per cent.* According to the 
mortality-statistics of the seventh census 
of the United States, of the males between 
the ages of twenty and fifty, in Mary- 
land, Virginia, North Carolina, South 
Carolina, and Georgia, Avhose deaths in 
the year ending June 1st, 1850,and their 
causes, were ascertained and reported by 
the marshals, 34.3 per cent, died of zy- 
motic diseases, 8 per cent, of all the dis- 
eases of the digestive organs, 30.8 per 
cent, .of diseases of the respiratory organs, 
24.4 per cent of fevers, and 5.7 per cent, 
of disorders of the brain and nervous sys- 
tem. In England and Wales, in 1858, 
these proportions were, zymotic 14 per 
cent, fevers 8 per cent, diseases of di- 
gestive organs 7.9 per cent., of lungs 8 
per cent, and of the brain 7 per cent, f 

If, however, we analyze the returns of 
mortality in civil life, and distinguish those 
of the poor and neglected dwellers in the 
crowded and filthy lanes and alleys of 
cities, whose animal forces are not well 
developed, or are reduced by insuffi- 
cient and uncertain nutrition, by poor 
food or bad cookery, by foul air within 
and stenchy atmosphere without, by im- 
perfect protection of house and clothing, 
we shall find the same diseases there as 
in the army. Wherever the vital forces 
are depressed, there these diseases of low 

* Calculated from the Eir/litcentk Registra- 
tion Report. 

+ Calculated from Twenty-First Report of 
Registrar General. 



vitality happen most frequently and are 
most fatal. 

Volumes of other facts and statements 
might be quoted to show that military ser- 
vice is exhaustive of vital force more than 
the pursuits of civil life. It is so even in 
time of peace, and it is remarkably so in 
time of war. Comparing the English state- 
ments of the mortality in the army with 
the calculations of the expectation of life 
in the general community, the difference 
is at once manifest. 

Of 10,000 men at the age of twenty, 
there will die before they complete their 
fortieth year, — 

British army in time of i)eace, .... 3,058 
England and Wales, English Life-Table, 1,853 
According to tables of Amicable and 

Equitable Life-insurance Companies, 1,972 
New England and New York, accord- 
ing to the tables of the New-England 
Mutual Life-insurance Companj-, . 1,721 



DANGERS IN LAND-BATTLES. 

This large amount of disease and mor- 
tality in the army arises not from the 
battle-field, but belongs to the camp, the 
tent, the barrack, the cantonment ; and it 
is as certain, though not so great, in time 
of peace, when no harm is inflicted by 
the instruments of destruction, as in time 
of war. The battle, which is the world's 
terror, is comparatively harmless. The 
official histories of the deadly struggles 
of armies show that they are not so waste- 
ful of life as is generally supposed. Mr. 
William Barwick Hodge examined the 
records and despatches in the War-Office 
in London, and from these and other 
sources prepared an exceedingly valua- 
ble and instructive paper on " The Mor- 
tality arising from Military Operations," 
which was read before the London Statis- 
tical Society, and printed in the nine- 
teenth volume of the Society's journal. 
Some of the tables will be as interesting 
to Americans as to Englishmen. On 
the following page is a tabular view, 
taken from this work, of the casualties 
in nineteen battles fought by the British 
armies with those of other nations. 



478 



Sanitary Condition of the Army. 



[October, 






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1862.] 



Sanitary Condition of the Army. 



479 



Of those who were engaged in these 
nineteen battles, one in 51.6, or 1.93 per 
cent., were killed. The deaths in con- 
sequence of the battles, including both 
those who died of wounds and those that 
died among the missing, were one in 
30, or 3.3 per cent, of all who were in 
the fight. It is worth noticing here, that 
the British loss in the Battle of New 
Orleans was larger than in any other bat- 
tle here adduced, except in that of Albu- 
era, in Spain, with the French, in 1811. 

In the British army, from 1793 to 
1815, including twenty-one years of war, 
and excluding 1802, the year of peace, 
the number of officers varied from 3,576 
in the first year to 13,248 in 1813, and 
the men varied from 74,500 in 1793 to 
276,000 in 1813, making an annual av- 
erage of 9,078 officers and 189,200 men, 
and equal to 199,727 officers and 4,168,- 
500 men serving one year. During these 
twenty-one years of war, among the offi- 
cers 920 were killed and 4,685 were 
wounded, and among the men 15,392 
were killed and 65,393 were wounded. 
This is an annual average of deaths from 
battle of 460 officers and 369 men, and 
of wounded 2,340 officers and 1,580 men, 
among 100,000 of each class. Of the of- 
ficers less than half of one per cent., or 
1 in 217, were killed, and a little more 
tlian two per cent., or 1 in 42, were 
wounded ; and among the men a little 
more than a third of one per cent., 1 in 
271, were killed, and one and a half per 
cent., 1 in 63, wounded, in each year. 
The compai'ative danger to the two is, 
of death, 46 officers to 37 men, and of 
wounds, 234 officers to 158 men. A lar- 
ger proportion of the officers than of the 
soldiers were killed and wounded ; yet a 
larger proportion of the wounded officers 
recovered. This is attributed to the fact 
that the officers were injured by rifle- 
balls, b^ing picked out by the marksmen, 
while the soldiers were injured by can- 



non- and musket-balls and shells, which 
inflict more deadly injuries. 

DANGERS IN NAVAL BATTLES. 

It may not be out of place here to show 
the dangers of naval warfare, which are 
discussed at length by Mr. Hodge, in a 
very elaborate paper in the eighteenth 
volume of the Statistical Society's journal. 
From one of his tables, containing a con- 
densed statistica\ history of the English na- 
vy, through the wars with France, 1 79^- ^ 
1815, the following facts are gathered. 

During those wars, the British Par- 
liament, in its several annual grants, vot- 
ed 2,527,390 men for the navy. But the 
number actually in the service is estimated 
not to have exceeded 2,424,000 in all, or 
a constant average force of 110,180 men. 
Within this time these men fought five 
hundred and seventy-six naval battles, 
and they were exposed to storms, to ship- 
wreck, and to fire, in every sea. In all 
these exposures, the records show that the 
loss of life was less than was suffered by 
the soldiers on the land. There were — 



Killed in battle, officers, 
" " men, 



Wounded, officers, 
" men. 



Drowned and otherwise destroyed in 

battle, 449 

Estimated deaths among the wounded, 1,427 

Total destroyed by battle, . . . 6,663 

Lost by shipwreck, accidental drown- 
ing, and by fire, .... 13,621 

Total deaths, from other causes than 
disease, 20,284 

Comparing the whole number of men 
in the naval service, during this period, 
with the mortality from causes incident to 
the service, the average annual loss was — 



. 


346 
4,441 


Total, 


4,787 

935 
13,335 


Total, 


14,270 



Killed in battle, one in 506, or .197 per cent. 

Drowned and lost in battle, and died of wounds, . . . one in 1,292, or .077 per cent. 

Wounded, one in 169, or .588 per cent. 

Drowned and lost by shipwreck, fire, etc., otherwise than by battle, one in 178, or .501 per cent. 

Total annual loss by battle and the special dangers of the sea, . one in 119, or .836 per cent. 



480 



Sanitary Condition of the Army. 



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1862.] 



Sanitary Condition of the Army. 



481 



Mr. Hodge's second table shows the 
conditions and casualties of thirteen bat- 
tles between fleets and squadrons. This 
is condensed and quoted on the preced- 
ing page. 

His third table includes thirty-five ac- 
tions with single ships on each side, be- 
tween the years 1793 and 1815. 8,542 
men were engaged, and 483, or 56.5 per 
1,000, were killed, and 1,230, or 144 per 
1,000, wounded. 

Twenty-six of these actions were with 
French ships, which are here omitted, 
and nine with American ships, which are 
shown in the second table on the preced- 
ing page.^ 

Thei-e is a very remarkable difference 
in the loss which the British suffered in 
naval and in land battles : — 



6 rt 


Vessels. 


Killed. 
One in 


Wound- 
ed. 
One in 


13 


Fleets 


64.0 
17.7 
19.8 

12.7 
30.0 


20.4 


35 

26 

9 

19 


Single ships 

French single ships. 
American do. do. 
Land battles 


6.9 
10.6 

4.4 
11.0 



The danger both of wounds and death 
in these contests was three times as 
great in the single ships as in fleets, and 
about five times as great in battles with 
the Americans as in fleet-battles with oth- 
er nations. The dangers in fleet-battles 
were about half as great as those in land- 
battles, and these were but little more 
than half as great as those in fights with 
single ships. 

COMPARATIVE DANGER OF CAMP AND 
BATTLE-FIELD. 

These records of land-battles show 
that the dangers from that cause are not 
very great ; probably they are less than 
the world imagines ; certainly they are 
much less than those of the camp. Of 
the 176,007 admitted into the regimental 
hospitals during the Peninsular War, on- 
ly 20,886 were from wounds, the rest from 
diseases ; fourteen-fifteenths of the bur- 

VOL. X. 31 



den on the hospitals in that war, through 
forty-two months, were diseased patients, 
and only one-fifteenth were wounded. In 
the Crimean War, 11.2 per cent, in the 
hospitals suffered from injuries in battle, 
and 88.8 per cent, from other causes. 10 
per cent, of the French patients in the 
same war were wounded, and 90 per cent, 
had fevers, etc. In the autumn of 1814, 
there were 815 patients in the great mil- 
itary hospital at Burlington, Vermont. 
Of these 50 were wounded, and the rest 
had the diseases of the camp. 

In the Crimean War, 16,296 died from 
disease, and 4,774 from injuries received 
in battle! In the Peninsular War, 25,304 
died of disease, and 9,450 from wounds. 

During eighteen years, 1840 to 1857, 
19,504 were discharged from the home, 
and 21,325 from the foreign stations of 
the British army. Of these, 541, or 2.7 
per cent, of those at home, and 3,703, or 
17.3 per cent, abroad, were on account 
of wounds and fractures, and the others 
on account of disease, debility, and ex- 
haustion. 



NATIONS DO NOT LEAUN FROM EXPE- 
RIENCE TO PREPARE FOR ARMY- 
SICKNESS. 

Nations, when they go to war, pre- 
pare to inflict injury and death on their 
opponents, and make up their minds to 
receive the same in return ; but they 
seem neither to look nor to prepare for 
sickness and death in their camps. And 
when these come upon their armies, they 
seem either to shut their eyes to the facts, 
or submit to the loss as to a disturbance 
in Nature, a storm, a drought, or an earth- 
quake, which they can neither prevent 
nor provide for, and for which they feel 
no responsibility, but only hope that it 
will not happen again. Nevertheless, 
this waste of life has followed every ar- 
my which has been made to violate the 
laws of health, in privations, exposures, 
and hardships, and whose internal history 
is known. The experience of such dis- 
astrous campaigns ought to induce Gov- 
ernments to inquire into the causes of the 



482 



Sanitary Condition of the Army. 



[October, 



suffering and loss, and to learn -whetlier 
they are not engaged in a struggle against 
Nature, in -which they must certainly fail, 
and endeavoring to make the human 
body bear burdens and labors which are 
beyond its strength. But Governments 
are slow to learn, especially sanitary les- 
sons. The British army suffered and 
died in great numbers at Walcheren and 
South Beveland, in the middle of the last 
century. Pringle described the sad con- 
dition of those troops, and warned his 
nation against a similar exposure ; yet, 
sixty years later, the Ministry sent anoth- 
er army to the same place, to sink under 
the malarious influences and diseases in 
the same way. The English troops at 
Jamaica were stationed in the low 
grounds, where, " for many generations," 
"the average annual mortality was 13 
per cent." " A recommendation for their 
removal from the plains to the mountains 
■was made so far back as 1 791. Numerous 
reports were sent to the Government, ad- 
vising that a higher situation should be 
selected"; but it was not until 1837, af- 
ter nearly half a century of experience 
and warning, that the Ministry opened 
their eyes to this cost of life and money in 
excessive sickness and mortality, and then 
removed the garrison to Maroontown, 
where the death-rate fell to 2 per cent., or 
less than one-sixth of what it had been.* 
. The American army, in the war with 
Great Britain fifty years ago, suffered 
from the want of proper provision for 
their necessities and comfort, from ex- 
posures and hardships, so that sometimes 
half its force was unavaihible ; yet, at the 
present moment, a monstrous army is col- 
lected and sent to the field, under the same 
regulations, and with the same idea of 
man's indefinite power of endurance, and 
the responsibility and superintendence of 
their health is left, in large measure, to 
an accidental and outside body of men, 
<he Sanitary Commission, which, although 
an institution of great heart and energy, 
and supported by the sympathies and co- 
operation of the whole people, is yet doing 

* Reporl on the Sanitary Condition of the Brit- 
ish Army, p. 212. Colonel Tulloch. 



a work that ought to be done by the Gov- 
ernment, and carrying out a plan of op- 
erations that should be inseparably asso- 
ciated with the original creation of the ar- 
my and the whole management of the war. 

CRIMEAN WAR. 

The lesson which the experience of 
the Russian army of 1828 and 1829 
taught the world of the mortal dangers 
of Bulgaria was lost on the British Gov- 
ernment, which sent its own troops there 
in 1854, to be exposed to, and wither 
before, the same destructive influences. 
But at length sickness prevailed to such 
an extent, and death made such hav- 
oc, in the army in the East, that Eng- 
land's great sympathies were roused, 
and the Ministers' attention was drawn 
to the irresistible fact, that the strongest 
of Britain's soldiers were passing rapidly 
from the camp to the hospital, and from 
the hospital to the grave. Then a doubt 
occurred to the minds of the men in 
power, whether all was right in the Cri- 
mea, and whether something might not be 
done for the sanitary salvation of the ar- 
my. They sent a commission, consisting 
of Dr. John Sutherland, one of the ablest 
sanitarians of the kingdom. Dr. Hector 
Gavin, and Robert Rawlinson, civil en- 
gineer, to the Black Sea, to inquire into 
the state of things there, to search out 
the causes of the sufferings of the arm)', 
and see if there might not be a remedy 
found and applied. At the same time, 
Miss Nightingale and a large corps of 
assistants, attendants, and nurses, women 
of station and culture and women of 
hire, went to that terrible scene of misery 
and death, to aid in any measures that 
might be devised to alleviate the condi- 
tion of the men. Great abuses and neg- 
ligence were found; and the causes of 
disease were manifest, manifold, and 
needless. But a reform was at once in- 
stituted ; great changes were made in the 
general management of the camp and 
hospitals and in the condition of the sol- 
diers. Disease began to diminish, the 
progress of mortality was arrested, and 



1862.] 



Sanitary Condition of the Army. 



483" 



in the course of a few ijionths the rate 
of death was as low as among men of 
the same ages at home. 

This commission made a full report, 
when they returned, and described the 
state of things they found in the Crimea 
and on the shores of the Black Sea, — 
the camps, barracks, huts, tents, food, 
manner of life, and general sanitary con- 
dition of the troops, their terrible suffer- 
ings, and the means and ways of caring 
for the sick, the measures of reform which 
they had proposed and carried out, and 
their effects on the health of the men. 
This report was published by the Gov- 
ernment. 

Besides this commission, the Govern- 
ment sent Dr. Lyons, a surgeon and pa- 
thologist of great learning and acumen, to 
investigate the pathology or morbid con- 
dition of the army. According to his in- 
structions, he spent four months in the 
Crimea and at the great hospitals on the 
Bosphorus. He examined and traced 
the course of disease and disturbance in 
the sick and wounded. He made very 
many thorough examinations after death, 
in order to determine the effects of vi- 
tiating influences upon the organization, 
and the condition of the textures and 
organs of the body in connection with 
the several kinds of disorders. Dr. Ly- 
ons's extremely instructive report was 
published by national authority as one of 
the Parliamentary folio volumes. After 
the war was over, Dr. W. llanbury and 
Staff-Surgeon Matthew, under the direc- 
tion of the Secretary of War, gathered, 
analyzed, and prepared the records of 
all the surgeons of the several corps of 
the Crimean army. To these they add- 
ed a long and valuable treatise on the 
nature and character of the diseases, 
and their connection with the condition 
and habits of the men. These are pub- 
lished in two very thick folio volumes, 
and give a minute and almost daily his- 
tory of the life, labors, exposures, priva- 
tions, sufferings, sickness, and mortality 
of each regiment. These two works, of 
Dr. Lyons and Drs. Hanbury and Mat- 
thew, show the inseparable connection 



between the manner of living and the 
health, and demonstrate that the severe 
life of war, with its diminished creation 
of vital force, by imperfect and uncertain 
nutrition and excessive expenditure in 
exposures and labors, necessarily breaks 
down the constitution. It subjects the 
body to more abundant disorders, and 
especially to those of the depressive, 
adynamic type, which, from the want 
of the usual recuperative power, are 
more fatal than the diseases of civil life. 
These works may be considered generic 
as well as specific. They apply to and 
describe the sanitary condition and the 
pathological history of all armies engag-. 
ed in hard and severe campaigns, as well 
as those of the Crimea. They should, 
therefore, be read by every Government 
that engages in or is forced into any war. 
They should be distributed to and thor- 
oughly understood by every commander 
who directs the army, and every sur- 
geon who superintends the sanitary con- 
dition of, and manages the sickness among, 
the men ; and happy will it be for those 
soldiers whose military and sanitary di- 
rectors avail themselves of the instructions 
contained in these volumes. 

There are several other works on the 
Crimean War, by surgeons and other of- 
ficers, written mainly to give a knowledge 
of the general facts of those campaigns, 
but all incidentally corroborating and 
explaining the statements In the Gov- 
ernment Reports, in respect to the health 
and sufferings of the British and French 
armies. In this view, Dr. Bryce's book, 
"England and France before Sebasto- 
pol," and M. Baudens's and M. Scrlve's 
medical works in French, are worthy of 
great attention and confidence. 

The most Important and valuable work, 
In this connection. Is the Report of the 
British Commission appointed in May, 
1854, "to inquire Into the regulations 
affecting the sanitary condition of the 
British army, the organization of the mil- 
itary hospitals, and the treatment of the 
sick and wounded." This commission in- 
cluded some of the ablest and most learn^ 
ed physicians and surgeons In the civil 



484 



Sanitary Condition of the Army. 



[October, 



and military service, some of the most 
accomplished statisticians, sanitarians, ar- 
my-officers, and statesmen in the United 
Kingdom. They were authorized to in- 
quire into the habits and duties, the mor- 
al and sanitary condition of the army, 
the amount and kinds of sickness, the 
causes and frequency of death, and the 
means of improvement. This commission 
sat for a long time in London. They 
called before them fifty-three ■witnesses, 
among whom were Sir Benjamin Brodie, 
the leading surgeon of England, Dr. An- 
drew Smith, Director-General of the 
Medical Department of the Army,Thomas 
Alexander, Inspector-General of Hospi- 
tals, Major-General Airey, Quartermas- 
ter-General, Dr. John Sutherland, late 
Crimean Commissioner, and one of the 
leading authorities of Groat Britain in all 
sanitary matters, Dr. William Farr, the 
chief and master-spirit of the Registry- 
Office, and the highest authority in vital 
statistics. Colonel Sir Alexander Tulloch, 
author of the elaborate and valuable re- 
ports on the mortality in the British ar- 
my, Francis G. P. Neison, author of "Con- 
tributions to Vital Statistics," Miss Night- 
ingale, and others, surgeons, officers, pur- 
veyors, engineers, soldiers, and medical 
and sanitary scholars. 

The commission put forth 10,070 in- 
terrogatories relating to everything con- 
nected with the army, the persons and 
the materiel, to officers, surgeons, phy- 
sicians, health-officers, soldiers, nurses, 
cooks, clothing, food, cooking, barracks, 
tents, huts, hospitals, duties, labors, ex- 
posures, and privations, and their effects 
on health and life, in every climate, 
wherever British troops are stationed or 
serve, at home and abroad. The same 
inquiry was extended to the armies of 
other nations, French, Turkish, Russian, 
etc. To these questions the witnesses re- 
turned answers, and statements of facts 
and opinions, all carefully prepared, and 
some of great length, and elaborate cal- 
culations in respect to the whole military 
and sanitary science and practice of the 
age. A large part of the inquiry was di- 
rected to the Crimean army, whose con- 



dition had been, and was then, a matter 
of the most intense interest. Many of 
the witnesses had, in various ways, been 
connected with that war: they were liv- 
miliar with its history, and their answers 
revealed much that had not before been 
known. The result of all this investiga- 
tion is published in a folio volume of 607 
pages, filled with facts and principles, the 
lamentable history of the past, painful de- 
scriptions of the present, and wise sug- 
gestions for the future management of 
the army; and the whole is worthy of the 
careful attention of all who, as projectors, 
leaders, or followers, have anything to do 
with the active operations of war. 

The Crimean "War has this remarkable 
interest, not that the suffering of the 
troops and their dejireciation in effective 
power were greater than in many oth- 
er wars, but that these happened in an 
age when the intelligence and philan- 
thropy, and even the policy of the nation, 
demanded to know whether the vital de- 
pression and the loss of martial strength 
were as great as rumor reported, wheth- 
er these were the necessary condition of 
war, and whether anything could be done 
to lessen them. By the investigations 
and reports of commissions, officers, and 
others, the internal history of this war 
is more completely revealed and better 
known than that of any other on record. 
It is placed on a hill, in the sight of all 
nations and governments, for their ob- 
servation and warning, to be faithful to 
the laws of health in providing for, and in 
the use of, their armies, if they would ob- 
tain the most efficient service from them. 



WANT OF SANITARY PP.EPARATIONS 
FOR WAR. 

There are, and have been, faults — 
grievous, destructive, and costly faults — 
in all connected with armies, from the 
Governments at the head, down through 
all grades of officers, to the men in the 
ranks : they are faults of theory and faults 
of practice, — of plan in those who direct, 
and of self-management in those whose 
whole duty is to obey. The root of this 



1862.] 



Sanitary Condition of the Army. 



485 



is the failure to full}' understand and 
count the cost, and to prepare to meet it 
as men generally do in tlie management 
of their common affairs. In civil life, 
when prudent men intend to effect any 
purpose by the aid of motive power, wheth- 
er of water, steam, horse, or other kind, 
they carefully consider the means of gen- 
erating that power, and the best and saf- 
est ways of applying and expending it. 
They include this in their plans, and make 
provision accordingly. Precisely deter- 
mining the extent of the purpose they de- 
sign to effect, and the amount of force 
that is and will be needed, they make 
their arrangements to provide or gener- 
ate and maintain so umch as long as they 
intend to do the work. During the whole 
process, they carefully guard and treasure 
it up, and allow none to be wasted or 
applied to any other than the appointed 
purpose. But in the use and manage- 
ment of the vital machines, the human 
bodies, by which the purposes of war are 
to be accomplished, nations are less wise. 
There are few, perhaps no records of any 
Government, which, in creating, maintain- 
ing, and operating with an army, lias, at 
and during the same time, created and 
established the never -failing means of 
keeping the machinery of war in the best 
working order, by sustaining the health 
and force of the men in unfailing fulness. 
War is carried on by a partnership 
between the Government and soldiers, to 
which the Government contributes money 
and directing skill, and assumes the re- 
sponsibility of management, and the sol- 
diers contribute their vital force. In the 
operation of this joint concern, both the 
money of the nation and the lives of the 
men are put at risk. Although, by the 
terms of the contract, the Government is 
presumed to expend its money and the 
soldiers' vital force to the extent that may 
be necessary to effect the objects of the 
association, it has no right to do this for 
any other purpose or on any other con- 
dition. It may send the men to battle, 
where they may lose in wounds or in death 
a part or all that they have contribut- 
ed ; but it has no right, by any negli- 



gence or folly on its own part or in its 
agents, _ to expend any of the soldiers' 
health or strength in hunger, nakedness, 
foul air, miasma, or disease. There is a 
glory attached to wounds, and even to 
death, received in a struggle with the 
enemies of one's country, and this is of- 
fered as a ])aTt of the compensation to 
the warrior for the risk that he runs ; 
but there is no glory in sickness or death 
from typhus, cholera, or dysentery, and 
no compensation of this kind comes to 
those who suffer or perish from these, in 
camp or military hospital. 

DIFFERENCE BETWEEN CIVIL AND MIL- 
ITARY LIFE. 

Military life, with the labors, ex- 
posures, and circumstances of war, differs 
widely from civil life. The social and do- 
mestic machinery of home spontaneous- 
ly brings within the reach of families the 
things that are needful for their suste- 
nance, comfortable for their enjoyment, 
and favorable to their health. But this 
self-acting machinery follows not the sol- 
dier through his campaigns. Everything 
he needs or enjoys is to be a matter of 
special thought, and obtained with a spe- 
cial effort and often with difficulty. Much 
that was very comfortable and salutary 
in civil life must be given up in the 
camp. The Government is the purvey- 
or for and the manager of the army ; it 
undertakes to provide and care for, to 
sustain and nourish the men. But, with 
all its wisdom, power, and means, it is 
not equal to the thousand or thousands 
of housekeepers that cared and provided 
for these men when at home ; and cer- 
tainly it does not, and probably cannot, 
perform these domestic offices as well and 
as profitably for the soldiers as their nat- 
ural providers did. Nevertheless, the 
Government is the sole provider for the 
army, and assumes the main responsibil- 
ity of the physical condition of its mem- 
bers. 

Starting with the very common belief 
that the human body has an indefinite 
power of endurance, or, if it suffer from 



486 



Sanitary Condition of the Army. 



[October, 



disease, or fall in death, it is from causes 
beyond man's control, — seeing, also., that it 
is impossible to carry the common means 
of sustaining life into the camp, Govern- 
ments seem willing to try the experiment 
of requiring their men to do the hard 
work of war without a certain, full supply 
of sustenance. They expect from the ar- 
my the largest expenditure of force, but 
sometimes give it the smallest means and 
poorest conditions of recuperating it. 

The business of war is not constant and 
permanent, like the pursuits of peace. It 
therefore comes to most managers as a 
new and unfamiliar work, to which they 
can bring little or no acquaintance from 
experience. They enter upon untried 
ground with imperfect knowledge of its 
responsibilities and dangers, and inade- 
quate conceptions of the materials and 
powers with which they are to operate. 
They therefore make many and some 
vei'y grave mistakes, every one of which, 
in its due proportion, is doubly paid for 
in drafts on the nation's treasury arid on 
the soldiers' vital capital, neither of which 
is ever dishonored. 

Military life is equally new to the sol- 
dier, for which none of his previous edu- 
cation or experience has fitted him. He 
has had his mother, wife, sister, or other 
housekeeper, trained and appointed for 
the purpose, to look after his nutrition, 
his clothing, his personal comfort, and, 
consequently, his health. These do not 
come without thought and labor. The 
domestic administration of the household 
and the care of its members require as 
much talent, intelligence, and discipline 
as any of the ordinary occupations of 
men. Througliout the civilized world, 
this responsibility and the labor necessa- 
ry for its fiilfihiicnt absorb a large por- 
tion of the mental and physical power 
of women. 

"When the new recruit enters the army, 
he leaves all this care and protection be- 
hind, but finds no substitute, no compen- 
sation for his loss in his new position. 
The Government supposes either that 
this is all unnecessary, or that the man 
in arms has an inspired capacity or an 



instinctive aptitude for self-care as well 
as for labor, and that he can generate 
and sustain physical force as well as ex- 
pend it. But he is no more fitted for this, 
by his previous training and habits, than 
his mother and wife are for making shoes 
or building houses by theirs. Neverthe- 
less he is thrown upon his own resources 
to do what he may for himself The ar- 
my-i-egulatlons of the United States say, 
" Soldiers are expected to preserve, dis- 
tribute, and cook their own subsistence " ; 
and most other Governments require the 
same of their men. Washing, mending, 
sweeping, all manner of cleansing, ar- 
rangement and care of whatever pertains 
to clothing and housekeeping, come under 
the same law of prescription or necessity. 
The soldier must do these things, or they 
will be left undone. He who has never 
arranged, cared for, or cooked his own or 
any other food, who has never washed, 
mended, or swept, is expected to under- 
stand and required to do these for him- 
self, or suffer the consequences of neg- 
lect. 

The want of knowledge and training 
for these purposes makes the soldier a 
bad cook, as well as an indiscreet, negli- 
gent, and often a slovenly self-manager, 
and consequently his nutrition and his 
personal and domestic habits are neither 
so healthy nor so invigorating as those 
of men In civil life ; and the Govern- 
ment neither thinks of this deficiency nor 
provides for It by furnishing instruction 
in regard to this new responsibility and 
these new duties, nor does It exercise a 
rigid watchfulness over his habits to com- 
pel them to be as good and as healthy 
as they may be. 

MUCH SICKNESS DUE TO ERRORS OF 
GOVERNMENT. 

Whatever may be the excess of sick- 
ness and mortality among soldiers over 
those among civilians, It is manifest that 
a great portion is due to preventable 
cause's ; and it is equally manifest that a 
large part of these are owing to the neg- 
ligence of the Government or its agents, 



1862.] 



Sanitary Condition of the Army. 



487 



the ofEcers in command or the men them- 
selves, in regard to encampments, tents, 
clothing, food, labors, exposures, etc. 

The places of encampment are usually 
selected for strategic purposes, or military 
convenience, and the soldiers are exposed 
to the endemic influences, whatever they 
may be. In some localities these influ- 
ences are perfectly salubrious ; in others 
they are intensely destructive. Malaria 
and miasms ofl'er to the unpractised eye 
of the military oflicer no perceptible signs 
of their presence. The camp is liable to 
be pitched and the men required to sleep 
in malarious spots, or on the damp earth, 
or over a wet subsoil, exposed to noisome 
and dangerous exhalations from which dis- 
ease may arise. Pringle says, that, in 1 798, 
the regiment which had 52 per cent, sick 
in two months, and 94 per cent, sick in 
one season, " were cantoned on marshes 
whence noxious exhalations emanated." * 
" Another regiment encamped where 
meadows had been flowed all winter and 
just drained, and half the men became 
sick." Lord Wellington wrote, August 
11, 1811, " Very recently, the officer com- 
manding a brigade encamped in one of 
the most unwholesome situations, and ev- 
ery man of them is sick."f One of our 
regiments encamped at Worcester, Mas- 
sachusetts, on the Agricultural Society's 
grounds, where the upper soil was not 
dry and the subsoil was wet. The men 
slept in tents on the ground, consequent- 
ly there were thirty to forty cases of dis- 
ordered bowels a day. The surgeon caus- 
ed the tents to be floored, and the disease 
was mitigated. The Eleventh Massachu- 
setts Regiment were encamped on a wet 
soil at Budd's Ferry, in Maryland. In a 
week, thirty cases of fever appeared. Dr. 
Ilussell, the surgeon, ordered the camp to 
be removed to a dry field, and the tents 
to be floored with brush ; no new cases 
of fever appeared afterward. Moltka 
says that " the Russian army Avhich suf- 
fered so terribly and fatally in 1828 and 
1829 was badly clothed and badly nour- 
ished, and in no way protected against 

* Diseases of the Army, p. 59. 
f Dtsjiatclics. 



the climate of the Danubian Provinces, 
and especially of Bulgaria, wliere the 
temperature varies from 58'' in the day 
to 29° at night, and where the falling dew 
is like a fine and penetrating rain." * 

Lord Wellington was a sagacious ob- 
server and a bold speaker. His despatch- 
es to his Government frequently mention 
the errors of those who should provide 
for the army, and the consequent suSer- 
ings of the soldiers. November 14, 1809, 
he says, " In the English army of 30,000 
men, 6,000 are sick." " Want of proper 
food increases sickness." " With nothing 
but Avater for drink, with meat, but no 
salt, and bread very rarely for a month, 
and no other food ; consequently, few, if 
any, were not affected with dysentery." 
Again he wi'ites, " Men cannot perform 
the labors of soldiers without food. Three 
of General Park's brigade died of famine 
yesterday, on their march; and above a 
hundred and fifty have fallen out from 
weakness, many of whom must have died , 
from the same cause." August 9, 1809, 
he wrote to Lord Castlereagh, " No 
troops can serve to any good purpose, 
unless they are regularly fed. It is an 
error to suppose that a Spaniard, or any 
man or animal of any country, can make 
an exertion without food." In February, 
1811, he wrote, "The Portuguese army 
of 43,000 or 44,000 men has about 9,000 
sick, which is rather more than a fifth. 
This is caused by want of proper and reg- 
ular food, and of money to purchase hos- 
pital-stores. If this be continued, the 
whole army will be down, or must be 
disbanded." 

The British army In Spain suffered 
from want of clothing as well as of food. 
The Duke, who did not intend to be mis- 
understood, nor believe that this was with- 
out somebody's fault, wrote, November 3, 
1810, to General Fane, " I wish it were 
in my power to give you well-clothed 
troops or hang those who ought to have 
given them clothing." 

The diaries of the medical ofEcers in 
the Crimean army, quoted in the " Med- 

* Boudin, Traite de Geograplde et de Statis' 
tique Medicates, Tom. II. p. 289. 



488 



Sanitary Condition of the Army. 



[October, 



ical and Surgical History" of that war, 
already referred to, are full of similar 
complaiuts, and these are supported by 
Dr. Lyons's " Pathological Report." One 
says, " Some of the camps were very in- 
judiciously chosen." " The men were 
very much weakened," " unable to un- 
dergo any fatigue," even " to carry their 
knapsacks." "At Balaklava, they built 
their huts on a very unhealthy site." Sir 
John Hall, Inspector-General of Hospi- 
tals, referring to this, said, '• I protested 
against it, in the strongest way I could, 
but without effect ; and the consequence 
was that shortly after the men had spot- 
ted fever." * Dr. Hanbury says, " No- 
vember, 1854. Health of the army rap- 
idly deteriorated from defective diet, 
harassing duties, hardships, privations, 
and exposures to the inclement season." 
" Cholera increased ; cold, wet, innutri- 
tious and irritating diet produced dysen- 
tery, congestion and disorganization of 
the mucous membrane of the bowels, and 
scurvy." January, 1855, he says, "Fe- 
ver and bowel affections indicated morbid 
action ; scurvy and gangrene indicated 
privation and exposures." 

The surgeon of the Thirty -Fourth 
Regiment writes: "November, 1854. 
Cholera broke out. It rained constantly. 
Troops had no other protection from the 
damp ground than a single wet blanket." 
" Without warm clothing, on short al- 
lowance of provisions, in want of fuel." 
" The sanitary condition of the regiment 
deteriorated rapidly: 5G per cent, of the 
men admitted to the hospital." 

Forty-First Regiment, November and 
December. " No respite from severe du- 
ties ; weather cold and wet ; clothing ill- 
adajited for such climate and service; 
disease rapidly increased ; 70 per cent, 
of the men in the hospital in two 
months." 

Thirty- Third Regiment, December, 
1854. " Cold and wet weather, coupled 
Avith insufficient food, fuel, and clothing, 
and severe and arduous duties, all com- 
bined to keep up the sickness; 48.8 per 

* Report on the Sanitary Condition of the 
British Arinij, p. 178. 



cent, admitted to the hospital in this 
month." 

Twentieth Regiment. " The impover- 
ished condition of the blood, dependent 
on long use of improper diet, exposure 
to wet and cold, and want of sufficient 
clothing and rest, had become evident." 
" Scurvy, diarrhcea, frost-bite, and ulcer- 
ation of the feet followed." 

First Regiment. " December, 1854. 
Scarcely a soldier in perfect health, from 
sleeping on damp ground, in wet cloth- 
ing, and no change of dress; cooking 
the worst; field -hospital over-crowded." 
"January, 1855. Type of disease be- 
coming more unequivocally the result of 
bad feeding, exposure, and other hard- 
ships." 

Thirtieth Regiment. " Duties and em- 
ployments extremely severe ; exposure 
protracted ; no means of personal clean- 
liness ; clothing infested with vermin ; 
since Nov. 14, short allowance of meat, 
and, on some days, of biscuit, sometimes 
no sugar, once no rice ; food sometimes 
spoiled in cooking ; tents leaked ; floors 
and bedding wet ; sanitary efficiency de- 
teriorated in a decided manner." 

These quotations are but samples of 
hundreds, perhaps thousands, of similar 
statements, showing the immediate con- 
nection between privations, exposures, 
and hardships, and depression of life and 
abundant disease. 

Dr. Sutherland went through all the 
camps, and makes similar statements. 
" The damp, unventilated, and undrained 
huts, in some parts of the camp, produced 
consequences similar to those In cellar- 
dwellings at home," — that is, typhus and 
typhoid diseases. " The half-buried huts 
of the Sardinian camp furnished a large 
proportion of fever cases among their 
occupants." " That beautiful village of 
Balaklava was allowed to become a hot- 
bed of pestilence, so that fever, dysentery, 
and cholera, in it and its vicinity and 
on the ships in the harbor, were abun- 
dant." " Filth, manure, offal, dead car- 
casses, had been allowed to accumulate to 
such an extent, that we found, on our 
arrival, in March, 1855, it would have 



1862.] 



Sanitary Condition of the Army. 



489 



required tlie labor of three hundred men 
to remove the local causes of disease be- 
fore the warm weather set in."* Gen- 
eral Airey said : " The French Gen- 
eral Canrobert came to me, complain- 
ing of the condition in wliich his men 
were. He said ' they were dying in the 
mud.' " f 

Dr. Bryce, one of the anny-surgcons 
in that war, says, in his book : " The 
British army was exhausted by over- 
work and the deficiency of everything 
that would sustain health and strength." 

AVlieu the soldier, overcome by these 
morbific influences, became sick, and was 
taken to the hospital, he was still com- 
pelled to suffer, and often sank under, the 
privation of those comforts and means of 
restoration which the sick at home usual- 
ly enjoy. 

Dr. Sutherland says : " The hospitals 
at Scutari were magnificent buildings, 
apparently admirably adapted to their 
purpose ; but, when carefully examined, 
they were found to be little better than 
pest-houses." X 

Under direction of the Sanitary Com- 
mission, the hospitals were cleansed and 
ventilated, and the patients allowed more 
room. In the first three weeks of these 
improvements, the mortality from diseas- 
es fell to one-half; in the second three 
weeks, to one-third; in the third, to one- 
fifth ; and in the fourth and fifth periods, 
to one-tenth of that which prevailed be- 
fore they were begun. § 

The reform was carried through the 
•whole army, camp and barracks. Govern- 
ment supplies, and soldiers' habits and 
exposures; and the mortality from dis- 
eases, which had been at the annual rate 
of 114 per cent, in January, and 83 per 
cent, in February, fell to 19 per cent, in 
April and May, 5 per cent, in the au- 
tumn, and l.G per cent, in the winter 
following. II 

* Report of the Sanitary Commission. — Re- 
port on the Sanitary Condition of the British 
Army, p. 335. 

t Rejiort of the Sanitary Condition of the Brit- 
ish Army, p. 97. 

X lb., p. 33i. § lb., p. 365. II lb., p. 52i. 



The exposures, privations, and suffer- 
ings of our own army in the last war 
with Great Britain, heart-rending even 
at this distance of time, were sufficient to 
account for much of the terrible sickness 
and mortahty that prostrated and de- 
stroyed the men. They were at times 
in want of food, clothing, and tents; and 
)et, in the new and unsettled country, in 
the wilderness and forest, they performed 
great labors. " Long and unremitting 
exposures to wet, cold, and fatigue, with 
a diet which, under existing circum- 
stances, could not prove nutritious, ex- 
hausted the vital principle, and diarrhoea 
and typhus fever supervened. The pro- 
duction of animal putrefaction and excre- 
mentitious materials were also sources 
of these diseases. Armies always accu- 
mulate these noxious principles about 
their encampments in a few days, when 
attention is not called to their daily re- 
moval." * Feeble, and destitute of cloth- 
ing and provisions, they invaded Canada 
attheendof the autumn in 1813. "During 
the whole of October and part of Novem- 
ber, most of them were subjected to ex- 
cessive fatigues, and exposed in open 
boats on the lake, when it rained almost 
every day." " On the 14th of Novem- 
ber the weather became intensely cold, 
and remained so all winter. In addition 
to their great fatigue, most of them lost 
their extra clothing and blankets on their 
march and in the battle of the 11th. 
Even the sick had no covering but tents 
until January. Provisions were scarce, 
and of a bad quality. Under these cir- 
cumstances, sickness and mortality were 
very great." " Nearly one - half of the 
army," 47 per cent., "were unfit for du- 
ty." f 

" Through the following winter, the want 
of necessaries for the support of the en- 
feebled and wretched soldier was most se- 
verely felt The poor subsistence which 
bread of the worst quality afforded was 
almost the only support which could be 
had for seven weeks." " The sickness, 

* Dr. Mann, Medical Sketches, p. 64. 
t Dr. Lovell, quoted by Mann, Medical 
Sketches, p. 119. 



490 



Sanitary Condition of the Army. 



[October, 



deaths, and distress at Frencli Mills ex- 
cited much alarm. This great mortality 
had obvious causes for its existence." 
" Predispositions to sickness, the effects 
of obvious causes, the comfortless condi- 
tion of men exposed to cold, wanting the 
common necessaries of life to support 
them in their exhausted states." Dr. 
Lovell adds : " It was impossible for 
the sick to be restored with nothing to 
subsist upon except damaged bread."* 
Among the causes of the abundant sick- 
ness, in March, along the Niagara fron- 
tier, given by the surgeons, were " severe 
duty during the inclement weather, ex- 
posure on the lake in open transports, 
bad bread made of damaged flour, either 
not nutritious or absolutely deleterious, 
bad water impregnated with the product 
of vegetable putrefaction, and the effluvia 
from materials of animal production with 
which the air was replete." f " The ar- 
my, in consequence of its stationary posi- 
tion, suffered from diseases aggravated by 
filth accumulated in its vicinity." " The 
clothing was not sufficient to protect the 
men on the northern frontier, and even 
this short allowance failed to reach them 
in due season." :|: " The woollen gar- 
ments have not been issued until the 
warm weather of summer commenced, 
when winter finds them either naked or 
clad in their summer dresses, perishing 
with cold." § 

The camps were sometimes in mala- 
rious districts. '' At Fort George and 
the vicinity, the troops were exposed to 
intense heat during the day and to cold 
and chilly atmosphere at night." " The 
diseases consequent to this exposure, ty- 
phus and intermittent fever, dysentery 
and diarrhoea," and " but little more 
than half of the men were fit for duty."|| 

Gen. Scott wrote from Mexico, Febru- 
ary 14, 1848 : " The army is also suffer- 
ing from the want of necessary clothing. 
The new troops are as destitute as the 
others. They were first told that they 
should find abundant supplies at New 

* Mann, Medical Sketches, pp. 120, 121. 
t lb., p. 78. I lb., p. 92. 

§i5., p. 124. II 76., p. 204. 



Orleans, next at Vera Cruz, and finally 
here." * 

There is ever a danger of the sensibil- 
ities and perceptive faculties becoming 
blunted by exposure to and familiarity 
with offensive effluvia. " The General 
repeatedly called the attention of the of- 
ficers at Fort George to the filthy state 
and foul effluvia of their camp, but they 
perceived no offensive odor ; their olfac- 
tories had lost their acuteness, and failed 
to warn them of the noisome gases that 
pervaded the atmosphere."! If the offi- 
cers fail of their duty as housekeepers to 
see that everything in the camp and tents 
is clean and healthy, the men fall into 
negligent habits, and become dirty and 
sick. It was the " total Avant of good po- 
lice" that reduced the regiment already 
referred to from 900 to 200 fit for duty. 
On the other hand, " The regiment of ar- 
tillery, always subject to correct discipline, 
with quarters and encampments always 
in the best state, and the men mostly neat 
and clean, suffered less by disease than 
any on the northei'n frontier. Their bet- 
ter health may be much imputed to clean- 
liness." J 

Itch and lice, the natural progeny of 
negligence and uncleanness, often find 
their home in the army. Pringle, more 
than a hundred years ago, said that 
" itch was the most general distemper 
among soldiers." Personal and house- 
hold vermin seem to have an instinctive 
apprehension of the homes that are pre- 
pared for them, and flock to the families 
and dwellings where washing and sweep- 
ing are not the paramount law and un- 
failing habit. They are found in the 
houses and on the bodies of the filthy 
and negligent everywhere. They espe- 
cially delight in living with those who 
rarely change their body-linen and bed- 
ding. They were carried into and es- 
tablished themselves in the new barracks 
of Camp Cameron in Cambridge, Massa- 

* Executive Documents, U. S., 1848, Vol. 
VII. p. 1224. 

t Mann, Medical Sketches, p. 66. 
t lb., p. 39. 



1862.] 



Sanitary Condition of the Army. 



491 



chusetts ; but they are never found in 
the Boston House of Correction, which 
receives its recruits from the filthiest dens 
of iniquity, because the energetic mas- 
ter enforces thorough cleansing on every 
new-comer, and continues it so long as 
he remains. 

The camps and police of the present 
Union army, though better than the av- 
erage of others and far above some, are 
yet not in as healthy condition as they 
might be. The Report of the Sanitary 
Commission to the. Secretary of AVar, 
December, 1861, says: "Of the camps 
inspected, 5 per cent, were in admirable 
order, 45 per cent, fairly clean and well 
policed. The condition of 26 per cent, 
was negligent and slovenly, and that of 
24 per cent, decidedly bad, filthy, and 
dangerous."* The same Report adds: 
" On the whole, a very marked and grat- 
ifying improvement has occurred during 
the summer." And that improvement 
has been going on ever since. Yet the 
description of a camp at Grafton, Vir- 
ginia, in March, shows that there a ve- 
ry bad and dangerous state of things 
existed at that time, and " one-seventh 
of the regiment was sick and unfit for 
duty " ; but the bold and clear report of 
Dr. Hammond of the United States Ar- 
my produced a decided and favorable 
change, and " the regiment has now less 
than the average amount of sickness." f 

The hospitals of the army are mostly 
buildings erected for other purposes, and 
not fitted for their j^resent use ; and the 
sudden influx of a large military popu- 
lation, with its usual amount of sickness, 
has often crowded these receptacles of 
the suffering soldiers. For want of ex- 
perience on the part of the officers, sur- 
geons, nurses, and men, in the manage- 
ment of such establishments, they are 
sometimes in very bad and unhealthy 
condition. In Cumberland, Maryland, 
fifteen buildings were occupied by about 
five hundred patients. These buildings 
had been warehouses, hotels, etc., with few 
or none of the conveniences for the sick. 

* p. 23. 

t Report of the Sanitary Commission, No. 41. 



They were densely crowded ; in some the 
men were " lying on the floor as thickly as 
they could be packed." One room with 
960 feet of air contained four patients. 
Dr. Hammond's description of the eighty- 
three rooms and the condition of the pa- 
tients in them seems to justify the terms 
he frequently uses. " Halls very dirty." 
" Rooms dismal and badly ventilated." 
" Utmost confusion appears to exist about 
each hospital ; consequentl}', duties are 
neglected, and a state of the most dis- 
gusting want of cleanliness exists." * 
Happily, the wise and generous sugges- 
tions of the surgeon were carried out, and 
with the best results. This hospital was 
an exception ; but it shows the need of 
intelligent watchfulness on the part of the 
Government. 



CROWDED QUARTERS. 

It is to be expected that the soldier's 
dwelling, his tent and barrack, will be 
reduced to the lowest endurable dimen- 
sions in the campaign, for there is a 
seeming necessity for this economy of 
room ; but in garrisons, stations, and can- 
tonments, and even in encampments in 
time of peace, this necessity ceases, and 
there is a power at least, if not a dis- 
position, to give a more liberal supply 
of house- and lodging-room to the army, 
and a better opportunity for rest and re- 
cuperation. In common dwelling-hous- 
es, under favorable circumstances, each 
sleeper is usually allowed from 500 to 
1,000 cubic feet of space : a chamber fif- 
teen or sixteen feet square and eight 
feet high, with 1,800 to 2,048 feet of air, 
is considered a good lodging-room for 
two persons. This gives 900 to 1,024 
feet of air for each. The prudent al- 
ways have some means of admitting 
fresh air, or some way for the foul 
air to escape, by an open window, or 
an opening into the chimney, or both. 
If such a room be occupied by three 
lodgers, it is crowded, and the air be- 
comes perceptibly foul in the night. 
Sometimes more are allowed to sleep 

* Report of the Sanitary Commission,^ o. 41. 



492 



Sanitary Condition of the Army. 



[October, 



•wltliin a room of this size ; but it is a 
matter of necessity, or of lower sensibil- 
ity, and is not healthy. They do not 
find sufficient oxygen to purify or de- 
carbonize their blood through the night j 
they consequently are not refreshed, nor 
invigorated and fully prepared for the 
labors of the following day. 

No nation has made this liberal and 
proper provision of lodging-room for its 
sleeping soldiers in peace or in war, in 
gai'rison or in the encampment. 

The British army-regulations formerly 
allowed 400 to 500 cubic feet for each sol- 
dier in barracks in temperate climates, 
and 480 to fiOO in tropical climates. The 
new regulations allow 600 feet in tem- 
perate climates.* But the 356 barracks 
at the various military stations in Great 
Britain and Ireland give the soldiers 
much less breathing-room than the more 
recent regulations require. Of these, 

3 allow 100 to 200 feet for each man. 

27 " 200 to 300 " " 

123 " 300 to 400 " " 

125 " 400 to 500 " " 

59 " 500 to 600 " " 

19 " 000 to 800 " " t 

The French Government allows 444 
feet for each infantry soldier, and 518 
feet for each man in the cavalry. 

The British soldiers, at these home-sta- 
tions, have less breathing-space and are 
subject to more foulness of air than the 
people of England in civil life ; and the 
natural consequence was discovered by 
the investigation of the Military Sanitary 
Commission, that consumption and oth- 
er diseases of the lungs wore much more 
prevalent and fatal among these soldiers, 
who were originally possessed of perfect 
constitutions and health, than among the 
people at large. The mortality from con- 
sumption and other diseases of the respi- 
ratory organs, among the Household Cav- 
alry, the Queen's Body-Guard, and the 
most perfectly formed men in the king- 
dom, was 25 per cent., among the Dra- 
goon Guards 59 per cent., among the 

* Report of Barrack Commission, p. 160. 
t Report on the Sanitary Condition of the 
British Army, p. 439. 



Infantry of the Line 115 per cent., and 
among the Foot-Guards 172 per cent, 
greater than it was among the males of 
the same ages throughout England and 
Wales, and consumption was the prevail- 
ing cause of death. 

The huts of the British army are of 
various sizes, holding from twenty-five to 
seventy-two men, and allowing from 146 
to 165 cubic feet for each. The " Ports- 
mouth hut " is the favorite. It is twenty- 
seven feet long, fifteen feet wide, walls 
six feet, and ridge twelve feet high. 
This holds twenty-five men, and allows 
146 feet of air to each man. All these 
huts have windows, and most of them are 
ventilated through openings under tlie 
eaves or just below the ridge, and some 
through both. 

Some of the temporary barracks erect- 
ed at Newport News, Virginia, are one 
hundred feet long, twenty-two feet wide, 
and twelve and a half feet high at the 
ridge, and accommodate seventy-six men, 
giving each 360 feet of air. Some are 
larger, and allow more space ; others al- 
low less; in one each man has only 169 
feet of breathing-space. All these build- 
ings are well supplied with windows, 
which serve also for ventilators. 

In forts, the garrisons are usually more 
liberally supplied with sleeping-room, yet, 
on emergencies, they are densely crowd- 
ed. At Fort Warren, in Boston Harbor, 
two regiments were temporarily station- 
ed, in the summer of 1861. There was 
one large barrack divided into some large 
and many small rooms, and there was the 
usual supply of rooms in the casemates. 
There was one range of rooms in the bar- 
rack, each sixteen feet six inches long, 
seven feet four inches high, and varying 
in width from ten feet eight inches to 
thirteen feet two inches. In most of 
these rooms, including two of the narrow- 
est, twelve men slept. They had from 
105 to 119 feet of air for each one. 
There was a large window in each room, 
which was opened at night, and might 
have served for healthy ventilation, ex- 
cept that there was an accumulation of 
disgusting filth within a few feet of the 



18G2.] 



Sanitary Condition of the Army. 



493 



building, on that side, sending forth of- 
fensive and noisome effluvia, and render- 
ing it doubtful which was the most disa- 
greeable and dangerous, the foul air with- 
in or the foul atmosphere without. In 
two of the casemate-rooms, holding sixty 
and seventy-five men respectively, each 
man had 144 and 180 feet of air. At 
Fort Independence, in the same harbor, a 
battalion was stationed, and slept in thir- 
teen casemate-rooms, where the men had 
from 150 to 297 feet of air. All the case- 
mate-rooms, being in the thick walls, and 
covered with earth, in both forts, were cold 
and damp, and many of them were kept 
comfortable only by fires, even in June. 

The ten new barracks at Camp Cam- 
eron, in Cambridge, when full, according 
to the plan, give each soldier 202 feet of 
air for respiration ; but in August last, 
when densely filled, as some of them 
were, the proportion of air for each man 
was reduced to 120 feet. The doors and 
windows were left open at night, howev- 
er, and obviated in some degree the evil 
effects of the crowding. 



The portable house must necessarily 
be as small as possible, and must be made 
to give its occupants the smallest endura- 
ble space. The English bell-tent con- 
tains 512 cubic feet, and lodges twelve 
to fifteen men, when on march, and eight 
to twelve men in camp, affording 34 to 
64 feet of breathing-space for each. 
Quartermaster-General Airey says this 
is the best tent in use. 

The American tents are of many vari- 
eties in shape and size. The Sibley tent 
gives 1,052 feet to seventeen or eighteen, 
and sometimes to twenty men, being 53 
to 62 feet for each. The Fremont tent 
is somewhat larger, and, as used in the 
cavalry camp at Readville, gave the men 
more air than the Sibley. Both of these 
have means of ventilation. The wedge- 
tent, being the simplest in structure, is 
most easily pitched, struck, and packed 
by the soldiers, and therefore used by 58 
per cent, of the regiments of the Union 



army, six men sleeping in each. But, 
as occupied by two of the regiments in 
Massachusetts, in the summer of 1861, it 
was the most crowded and unhealthy. 
Those used by the Second Regiment at 
West Roxbury, and the Ninth at Long 
Island, (in Boston Harbor,) were twelve 
and a half feet long, eight feet wide, and 
six feet high to the ridge, and held twelve 
men. Each sleeper had 8^ square feet 
of floor to rest upon, and 25 cubic feet 
of air to breathe through the night, with 
no ventilation, except what air passed in 
through the door- way, when left open, 
and through the porous cloth that cover- 
ed the tent. Some of the tents of one 
of the regiments encamped at Worcester 
had 56 feet of floor-surface, and 160 feet 
of air, which was divided among six men, 
giving each 27 feet of air. 

In all the camps of Massachusetts, and 
of most armies everywhere, economy, 
not only of room within the tents, but of 
ground where they are placed, seems to 
be deemed very important, even on those 
fields where there is opportunity for in- 
definite expansion of the encampment. 
The British army -regulations prescribe 
three plans of arranging the tents. The 
most liberal and loose arrangement gives 
to each soldier eighty square feet of 
ground, the next gives ■ forty-two, and 
the most compact allows twenty-seven 
feet, without and within his tent. These 
are densities of population equal to hav- 
ing 348,000, 664,000, and 1,008,829 peo- 
ple on a square mile. But enormous and 
incredible as this condensation of human- 
ity may seem, we, in Massachusetts, have 
beaten it, in one instance at least. In 
the camp of the Ninth Regiment at Long 
Island, the tents' were placed in compact 
rows, and touched each other on the two 
sides and at the back. Between the al- 
ternate rows there were narrow lanes, 
barely wide enough for carriages to pass. 
Thus arranged, the men, when in their 
tents, were packed at the rate of 1,152,000 
on a square mile, or one man on every 
twenty -two squafe feet, including the 
lanes between, as well as the ground un- 
der, the tents. 



494 



Sanitary Condition of the Army. 



[October, 



The city of London has 17,678 persons 
on a square mile, through its whole ex- 
tent, including the open spaces, streets, 
squares, and parks. East London, the 
densest and most unhealthy district, has 
175,816 on a mile. Boston, including 
East and South Boston, but not Washing- 
ton Village, has 50,805 on a mile ; and 
the Broad -Street section, densely filled 
with Irish families, had, when last exam- 
ined for this purpose, in 1845, a density 
of population at the rate of 413,000 on 
the same space. 

EESULTS OF SANITARY REFORMS. 

The errors and losses which have been 
adverted to are not all constant nor uni- 
versal : not every army is hungry, or has 
bad cookery; not every one encamps in 
• malarious spots, or sleeps in crowded tents, 
or Is cold, wet, or overworked : but, so far 
as the internal history of military life has 
been revealed, they have been and are 
sufficiently frequent to produce a great- 
er depression of force, more sickness, 
and a higher rate of mortality among the 
soldiery than are found to exist among 
civilians. Every failure to meet the nat- 
ural necessities or wants of the animal 
body, in respect to food, air, cleanliness, 
and protection, has, in Its own way, and 
in its due proportion, diminished the pow- 
er that might otherwise have been cre- 
ated ; and every misapplication has again 
reduced that vital capital which was al- 
ready at a discount. These first bind the 
strong man, and then, exposing him to 
morbific influences, rob him of his health. 
Perhaps In none of the common alTalrs 
of the world do men allow so large a part 
of the power they raise and the means 
they gather for any purpose to be lost, 
before they reach their object and strike 
their final and etfectlve blow, as the rulers 
of nations allow to be lost in the gather- 
ing and application of human force to 
the purposes of war. And this is mainly 
because those rulers do not study and 
regard the nature and conditions of the 
living machines wltli which they operate, 
and the vital forces that move them, as 



faithfully as men in civil life study and 
regard the conditions of the dead ma- 
chines they use, and the powers of water 
and steam that propel them, and form 
their plans accordingly. 

But it is satisfactory to know that great 
improvements have been made in this re- 
spect. From a careful and extended in- 
quiry into the diseases of the army and 
their causes, it is manifest that they do not 
necessarily belong to the profession of 
war. Although sickness has been more 
prevalent, and death in consequence more 
frequent, In camps and military stations 
than in the dwellings of peace, this ex- 
cess is not unavoidable, but may be most- 
ly, if not entirely, prevented. Men are 
not more sick because they are soldiers 
and live apart from their homes, but be- 
cause they are exposed to conditions or 
Indulge in habits that would produce the 
same results In civil as in military life. 
Wherever civilians have fallen into these 
conditions and habits, they have suffered in 
the same way; and wherever the army has 
been redeemed from these, sickness and 
mortality have diminished, and the health 
and efficiency of the men have improved. 

Great Britain has made and is still 
making great and successful efforts to re- 
form the sanitary condition of her army. 
The improvement in the health of the 
troops in the Crimea In 185G and 1857 
has already been described. The reduc- 
tion of the annual rate of mortality caus- 
ed by disease, from 1,142 to 13 in a thou- 
sand, in thirteen months, opened the eyes 
of the Government to the real state of 
matters in the army, and to their own 
connection with it. They saw that the 
excess of sickness and death among the 
troops had its origin in circumstances 
and conditions which they could control, 
and then they began to feel the respon- 
sibility resting upon them for the health 
and life of their soldiers. On further 
investigation, they discovered that sol- 
diers in active service everywhere suffer- 
ed more by sickness and death than civil- 
ians at home, and then they very natu- 
rally concluded that a similar application 
of sanitary measures and enlbrcement of 



1862.] 



Sanitary Condition of the Army. 



495 



the sanitary laws would be as advanta- 
geous to the health and life of the men 
at all other places as in the Crimea. 
A thorough reform -was determined up- 
on, and carried out with signal suc- 
cess in all the military stations at home 
and abroad. " The late Lord Herbert, 
first in a royal commission, then in a 
commission for carrying out its recom- 
mendations, and lastly as Secretary of 
State for War in Lord Palmerston's ad- 
ministration, neglecting the enjoyments 
which high rank and a splendid fortune 
placed at his command, devoted himself 
to the sanitary reform of the army." * 
He saw that the health of the soldiers was 
perilled more " by bad sanitary arrange- 
ments than by climate," and that these 
could be amended. " He had some cour- 
ageous colleagues, among whom I must 
name as the foremost Florence Nightin- 
gale, who shares without diminishing his 
glory."! Both of these great sanitary 
reformers sacrificed themselves for the 
good of the suffering and perishing sol- 
dier. " Lord Herbert died at the age of 
fifty-one, broken down by work so en- 
tirely that his medical attendants hardly 
knew to what to attribute his death." % 
Although he probed the evil to the very 
bottom, and boldly laid bare the time- 
honored abuses, neglects, and ignorance 
of the natural laws, whence so much 
sickness had sprung to waste the army, 
yet he " did not think it enough to point 
out evils in a report; he got commis- 
sions of practical men to put an end to 
them."§ A new and improved code of 
medical regulations, and a new and ra- 
tional system of sanitary administration, 
suited to the wants and liabilities of the 
human body, were devised and adopted 
for the British army, and their conditions 
are established and carried out with the 
most happy results. 

These new systems connect with ev- 
ery corps of the army the means of pro- 

* Dr. Farr, in Journal of the London Statis- 
iical Society, Vol. XXIV. p. 472. 
t Ibid. 

X MS. Letter of Dr. Sutherland. 
§ Dr. Farr, uli supra. 



tecting the health of the men, as well as 
of healing their diseases. 

" The Medical Department of the Brit- 
ish army includes, — 

" 1. Director-General, who is the sole 
responsible administrative head of the 
medical service. 

" 2. Three Heads of Departments, to 
aid the Director-General with their ad- 
vice, and to work the routine-details. 

" A Medical Head, to give advice and As- 
sistance on all subjects connected with the 
medical service and hospitals of the army. 

'■ A Sanitary Head, to give advice and 
assistance on all subjects connected with 
the hygiene of the army. 

" A Statistical Head, who will keep 
the medical statistics, case-books, meteor- 
ological registers," etc.* 

Besides these medical oflacers, there 
are an Inspector-General of Hospitals, a 
Deputy Inspector- General of Hospitals, 
Staff and Regimental Surgeons, Staff 
and Regimental Assistant-Surgeons, and 
Apothecaries. 

The British army is plentifully sup- 
plied with these medical officers. For 
the army of 118,000 men there were pro- 
vided one thousand and seventy-five med- 
ical officers under full pay in 1859. Four 
hundred and seventy surgeons and as- 
sistant-surgeons were attached to the 
hundred regiments of infantry, f 

It is made the duty of the medical offi- 
cer to keep constant watch over all the 
means and habits of life among the troops, 
— " to see that all regulations for protect- 
ing the health of troops, in barracks, gar- 
risons, stations, or camps, are duly observ- 
ed." " He is to satisfy himself as to the 
sanitary condition of barracks," " as to 
their -jleanllness, within and without, their 
ventilation, warming, and lighting," " as 
to the drainage, ash-pits, offal," etc. " He 
is to satisfy himself that the rations arc 
good, that the kitchen -utensils are suffi- 
cient and in good order, and that the 
cooking is sufficiently varied." % 

* Army Medical Regulations, p. 27, etc. 
t lieport of the Army Medical Deimrtment 
for 1859. 

X Army Medical Regulations, p. 29. 



496 



Sanitary Condition of the Army. 



[October, 



Nothing in the condition, circumstan- 
ces, or habits of the men, that can affect 
their health, must be allowed to escape 
the notice of these medical officers. 

In every plan for the location or move- 
ment of any body of troops, it is made 
the duty of the principal medical officer 
first to ascertain the effect which such 
movement or location will have upon the 
men, and advise the commander accord- 
ingly. It is his duty, also, to inspect all 
camp-sites and " give his opinion in writ- 
ing on the salubrity or otherwise of the 
proposed position, with any recommenda- 
tions he may have to make respecting 
the drainage, preparation of the ground, 
distance of the tents or huts from each 
other, the number of men to be placed 
in each tent or hut, the state of clean- 
liness, ventilation, and water-supply."* 
" The sanitary officer shall keep up a 
daily inspection of the whole camp, and 
especially inform himself as to the health 
of the troops, and of the appearance of 
any zymotic disease among them ; and he 
shall immediately, on being informed of 
the appearance of any such disease, ex- 
amine into the cause of the same, wheth- 
er such disease proceed from, or is aggra- 
vated by, sanitary defects in cleansing, 
drainage, nuisances, overcrowding, de- 
fective ventilation, bad or deficient water- 
supply, dampness, marshy ground, or from 
any other local cause, or from bad or de- 
ficient food, intemperance, unwholesome 
liquors, fruit, defective clothing or shelter, 
exposure, fatigue, or any other cause, and 
report immediately to the commander of 
the forces, on such causes, and the re- 
medial measures .he has to propose for 
their removal." " And he shall report 
at least daily on the progress or decline 
of the disease, and on the means adopted 
for the removal of its causes." f 

Thus the British army is furnished with 
the best sanitary instruction the nation 
can aflbrd, to guide the officers and show 
the men how to live, and sustain their 
strength for the most effective labor in 
the service of the country. 

* Army Medical Regulations, p. 83. 
t 76., p. 84. 



To make this system of vigilant watch- 
fulness over the health of the men the 
more effectual, the medical officer of each 
corps is required to make weekly returns 
to the principal medical officer of the 
command, and this principal officer 
makes monthly returns to the central 
office at London. These weekly and 
monthly returns include all the matters 
that relate to the health of the troops, 
" to the sanitary condition of the bar- 
racks, quarters, hospitals, the rations, 
clothing, duties, etc., of the troops, and 
the effects of these on their health." * 

Under these new regulations, the exact 
condition of the army everywhere is al- 
ways open to the eyes of medical and 
sanitary officers, and they are made re- 
sponsible for the health of the soldiers. 
The consequence has been a great im- 
provement in the condition and habits 
of the men. Camps have been better 
located and arranged. Food is better 
supplied. Cooking is more varied, and 
suited to the digestive powers. The old 
plan of boiling seven days in the week 
is abolished, and baking, stewing, and 
other more wholesome methods of prepa- 
ration are adopted in the army-kitchens, 
witli very great advantage to the health 
of the men and to the efficiency of the 
military service. Sickness has diminish- 
ed and mortality very greatly lessened, 
and the most satisfactory evidence has 
been given from all the stations of the 
British army at home and abroad, that 
the great excess of disease and death 
among the troops over those of civilians 
at home is needless, and that health and 
life are measured out to the soldier, as 
well as to the citizen, according to the 
manner in which he fulfils or is allowed 
to fulfil the conditions established by Na- 
ture for his being here. 

The last army medical report shows the 
amount and rate of sickness and mortali- 
ty of every corps, both in the year 1859, 
under the new system of watchfulness 
and proper provision, and at a former 
period, under the old regime of neg- 
lect. 

*.Army diedical Regulations, p. 93. 



1862.] ^n -^rab Welcome. 497 

THE NUMBER OF DEATHS IN 100,000.* 

Annual Average for 10 years, 1837 to 1846. 1859. 

Household Cavalry 1,039 427 

Dragoon-Guards 1,208 .... 794 

Foot-Guards 1,872 859 

Infantry Regiments 1,706 .... 758 

Men in healthy districts of England 723 



The Foot-Guards, which lost annually 
1,415 from diseases of the chest before 
the reform, lost only 538 in 100,000 from 
the same cause in 1859.* 

Among the infantry of the line, the an- 
nual attacks of fever were reduced to a 
little more than one-third, and the deaths 
from this cause to two-fifths of their former 
ratio. The cases of zymotic disease were 
diminished 33 per cent., and the mortali- 
ty from this class of maladies was reduced 
68 per cent.f 

The same happy accounts of improve- 
ment come from every province and ev- 
ery military station where the British Gov- 
ernment has placed its armies. 

* Report of the Army Medical Department 
for 1859, p. 10. 
t Ibid. 



Our present army is in better condi- 
tion than those of other times and other 
nations ; and more and more will be done 
for this end. The Government, has al- 
ready admitted the Sanitary Commission 
into a sort of copartnership in the man- 
agement of the army, and hereafter the 
principles of this excellent and useful as- 
sociation will be incorporated with, and 
become an inseparable part of, the ma- 
chinery of war, to be conducted by the 
same hands that direct the movements 
of the armies, ever present and efficient 
to meet all the natural Avants of the sol- 
dier, and to reduce his danger of sickness 
and mortality, as nearly as possible, to 
that of men of the same age at home. 

* Report of the Army Mtdical Department 
for 1859, p. 6. 



AN ARAB WELCOME. 



Because thou com'st, a tired guest. 
Unto my tent, I bid thee rest. 
This cruse of oil, this skin of wine, 
These tamarinds and dates, are thine : 
And while thou eatest, Hassan, there, 
Shall bathe the heated nostrils of thy mare. 

II. 

Allah il Allah! Even so 
An Arab chieftain treats a foe : 
Holds him as one without a foult, 
Who breaks his bread and tastes his salt ; 
And, in fair battle, strikes him dead 
With the same pleasure that he gives him bread ! 



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